<%BANNER%>

Predictors of Successful Completion of Family Treatment Drug Court Programs

Permanent Link: http://ufdc.ufl.edu/UFE0022556/00001

Material Information

Title: Predictors of Successful Completion of Family Treatment Drug Court Programs An Archival Investigation
Physical Description: 1 online resource (117 p.)
Language: english
Creator: West, Rosa
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2008

Subjects

Subjects / Keywords: court, drug, family, substance, treatment
Counselor Education -- Dissertations, Academic -- UF
Genre: Marriage and Family Counseling thesis, Ph.D.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: Substance abuse greatly impact our nation?s children and the child welfare and protective service systems as many parents who abuse substances neglect or abuse their children as a result of their addiction. Family Treatment Drug Courts (FTDC) were developed to provide support for individuals in accessing and engaging in treatment. However, little is known about the factors associated with positive treatment outcomes from FTDC programs. This study examined six possible factors associated with successful completion of a FTDC program: (1) drug of choice, (2) frequency of drug use, (3) prior treatment history, (4) criminal status, (5) social support, and (6) prior Child Protective Service involvement. By means of an archival analysis of data from existing client records, a sample of 186 FTDC participants was developed. The total study consisted of 88.1% females and 11.9% males. Age was found to significantly differentiate successful from unsuccessful completers as the majority of participants who successfully completed treatment were either thirty-seven years of age or older or between 31-36 years old. The racial/ethnic composition of the study sample was, for the most part, either African-American (N=88, 47.6%) or Caucasian (N=92, 49.7%). Results of the hierarchical logistic regression analyses revealed that drug of choice, extent of prior treatment, and source of social support were significant predictors of successful treatment outcome. Unsuccessful completers were significantly more likely than successful completers to identify marijuana as their drug of choice and unsuccessful completers were significantly more likely than successful completers to report no prior treatment history. In addition, successful completers reported that they received social support from friends/family/spouse/partner significantly more than did unsuccessful completers. Based on our findings more research is needed that examines characteristics associated with successful completion of FTDC programs. In addition, research focused on perceptions of the effectiveness of treatment components is needed and the role of motivation on successful completion. Recommendations were also made regarding the need for further research examining gender differences in referral to FTDC programs, influence of co-occurring disorders on successful outcomes, and the impact of FTDC programs on future involvement of participants in the child welfare system.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Rosa West.
Thesis: Thesis (Ph.D.)--University of Florida, 2008.
Local: Adviser: Amatea, Ellen S.

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2008
System ID: UFE0022556:00001

Permanent Link: http://ufdc.ufl.edu/UFE0022556/00001

Material Information

Title: Predictors of Successful Completion of Family Treatment Drug Court Programs An Archival Investigation
Physical Description: 1 online resource (117 p.)
Language: english
Creator: West, Rosa
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2008

Subjects

Subjects / Keywords: court, drug, family, substance, treatment
Counselor Education -- Dissertations, Academic -- UF
Genre: Marriage and Family Counseling thesis, Ph.D.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: Substance abuse greatly impact our nation?s children and the child welfare and protective service systems as many parents who abuse substances neglect or abuse their children as a result of their addiction. Family Treatment Drug Courts (FTDC) were developed to provide support for individuals in accessing and engaging in treatment. However, little is known about the factors associated with positive treatment outcomes from FTDC programs. This study examined six possible factors associated with successful completion of a FTDC program: (1) drug of choice, (2) frequency of drug use, (3) prior treatment history, (4) criminal status, (5) social support, and (6) prior Child Protective Service involvement. By means of an archival analysis of data from existing client records, a sample of 186 FTDC participants was developed. The total study consisted of 88.1% females and 11.9% males. Age was found to significantly differentiate successful from unsuccessful completers as the majority of participants who successfully completed treatment were either thirty-seven years of age or older or between 31-36 years old. The racial/ethnic composition of the study sample was, for the most part, either African-American (N=88, 47.6%) or Caucasian (N=92, 49.7%). Results of the hierarchical logistic regression analyses revealed that drug of choice, extent of prior treatment, and source of social support were significant predictors of successful treatment outcome. Unsuccessful completers were significantly more likely than successful completers to identify marijuana as their drug of choice and unsuccessful completers were significantly more likely than successful completers to report no prior treatment history. In addition, successful completers reported that they received social support from friends/family/spouse/partner significantly more than did unsuccessful completers. Based on our findings more research is needed that examines characteristics associated with successful completion of FTDC programs. In addition, research focused on perceptions of the effectiveness of treatment components is needed and the role of motivation on successful completion. Recommendations were also made regarding the need for further research examining gender differences in referral to FTDC programs, influence of co-occurring disorders on successful outcomes, and the impact of FTDC programs on future involvement of participants in the child welfare system.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Rosa West.
Thesis: Thesis (Ph.D.)--University of Florida, 2008.
Local: Adviser: Amatea, Ellen S.

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2008
System ID: UFE0022556:00001


This item has the following downloads:


Full Text

PAGE 1

PREDICTORS OF SUCCESSFUL COMPLETI ON OF FAMILY TREATMENT DRUG COURT PROGRAMS: AN ARCHIVAL INVESTIGATION By ROSA MARIE WEST A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLOR IDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2008 1

PAGE 2

2008 Rosa Marie W est 2

PAGE 3

To m y Mom and Dad, with love 3

PAGE 4

ACKNOWL EDGMENTS I would like to thank Dr. Ellen S. Amatea for chairing my committee and for her support and guidance. I also want to thank Dr. Peter Sherrard, Dr. Cirecie We st-Olatunji, and Dr. Stephanie Evans for their helpful feedback and sugge stions. I am especially grateful to Dr. Betsy Pearman for her assistance with data analysis and for her encouragement. I would like to thank my family and friends especially my best friend and partner, Nathaniel Gates. He continued to support and en courage me at times when this journey seemed unending. I would also like to thank Richard Anderson for his wisdom, encouragement, and guidance. I want to extend my deepest appreciati on to my friends at Meridian for offering their support, providing a social outlet when I was w eary, and showering me w ith love and spiritual guidance. Special appreciation and gratit ude go to my parents, Walte r and Alice West, who taught me the importance of education. Without their love and support, I would not be where I am today. I thank them for believing in me when I doubted myself and encouraging me when I thought I could not go on. 4

PAGE 5

TABLE OF CONTENTS page ACKNOWLEDGMENTS...............................................................................................................4 LIST OF TABLES................................................................................................................. ..........7 ABSTRACT.....................................................................................................................................8 CHAPTER 1 INTRODUCTION................................................................................................................. .10 Scope of the Problem........................................................................................................... ...11 Statement of the Problem....................................................................................................... .18 Need for the Study..................................................................................................................20 Purpose of the Study........................................................................................................... ....21 Theoretical Framework.......................................................................................................... .22 Hypotheses..............................................................................................................................27 Definition of Terms................................................................................................................28 Overview of Remainder of Study...........................................................................................31 2 LITERATURE REVIEW.......................................................................................................32 Adult Drug Courts.............................................................................................................. ....33 Family Treatment Drug Courts...............................................................................................35 Family Treatment Drug Court Process...................................................................................38 Variables under Study.......................................................................................................... ...44 Drug of Choice and Frequency........................................................................................44 Prior Treatment................................................................................................................45 Criminal Status................................................................................................................ 46 Social Support.................................................................................................................47 CPS Involvement.............................................................................................................48 Successful Completion....................................................................................................50 Summary.................................................................................................................................51 3 METHODOLOGY.................................................................................................................5 3 Population and Sample.......................................................................................................... .53 Measurement.................................................................................................................... .......56 Criminal Status................................................................................................................ 56 Drug of Choice................................................................................................................57 Frequency of Drug Use...................................................................................................58 Prior CPS involvement....................................................................................................58 Prior treatment history.....................................................................................................58 Social support................................................................................................................. .59 Successful Completion....................................................................................................59 5

PAGE 6

Null Hypotheses................................................................................................................ ......60 The following (seven) h ypotheses w ill be tested in this study:.......................................60 Data Collection.......................................................................................................................60 Data Analytic Procedures.......................................................................................................62 4 RESULTS...................................................................................................................... .........63 Description of the Sample...................................................................................................... 63 Age..........................................................................................................................................64 Education Level................................................................................................................ ......65 Stage of Treatment..................................................................................................................66 Criminal Status................................................................................................................ .......67 Drug of Choice.......................................................................................................................68 Drug of Choice: Single Drug use versus Multiple Drug Use.................................................69 Frequency of Use....................................................................................................................70 CPS Involvement....................................................................................................................71 Prior Treatment.......................................................................................................................72 Social Support.........................................................................................................................74 Hypothesis Testing............................................................................................................. ....77 Data Analysis..........................................................................................................................78 Summary of Findings............................................................................................................ .86 5 DISCUSSION................................................................................................................... ......89 Limitations.................................................................................................................... ..........89 Discussion of Findings......................................................................................................... ..91 Implications................................................................................................................... .........94 Recommendations for Future Research..................................................................................97 Summary...............................................................................................................................104 APPENDIX A DATA CODING.................................................................................................................. .106 REFERENCE LIST.....................................................................................................................108 BIOGRAPHICAL SKETCH.......................................................................................................117 6

PAGE 7

LIST OF TABLES Table page Table 4-1. Gender, Age, & Ethnicity............................................................................................ .65 Table 4-2. Education........................................................................................................... ...........66 Table 4-3. Criminal Status..................................................................................................... ........68 Table 4-4. Drug of Choice...................................................................................................... .......69 Table 4-5. Drug of Choice (Single Drug Use versus Multiple Drug Use)....................................70 Table 4-6. Frequency of Use.................................................................................................... ......71 Table 4-7. Prior CPS Involvement............................................................................................... ..72 Table 4-8. Prior Treatment History............................................................................................. ...74 Table 4-9. Social Support..............................................................................................................76 Table 4-10. Year of Admission.................................................................................................. ....77 Table 4-11. Regression Coefficients for Hierarchical Logistic Regression..................................80 Table 4-12. Logistic Regression Co efficients for Drug of Choice................................................81 Table 4-13. Logistic Regression Coe fficients for Frequency of Use.............................................82 Table 4-14. Logistic Regression Coe fficients for Prior Treatment................................................83 Table 4-15. Logistic Regression Coe fficients for Criminal Status................................................84 Table 4-16. Logistic Regression Co efficients for Social Support.................................................85 Table 4-17. Logistic Regression Coefficients for Prior Child Protective Service Involvement....86 7

PAGE 8

Abstract of Dissertation Pres ented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy PREDICTORS OF SUCCESSFUL COMPLETION OF FAMILY TREATMENT DRUG COURT PROGRAMS: AN ARCHIVAL INVESTIGATION By Rosa Marie West August 2008 Chairperson: Ellen S. Amatea Major: Marriage and Family Counseling Substance abuse greatly impact our nations ch ildren and the child welfare and protective service systems as many parents w ho abuse substances neglect or abuse their children as a result of their addiction. Family Treatment Drug Cour ts (FTDC) were developed to provide support for individuals in accessing and engaging in treatment. However, little is known about the factors associated with positive treatment outcome s from FTDC programs. This study examined six possible factors associated with successful completion of a FTDC program: (1) drug of choice, (2) frequency of drug us e (3) prior treatment history, (4 ) criminal status, (5) social support, and (6) prior Child Pr otective Service involvement. By means of an archival anal ysis of data from existing c lient records, a sample of 186 FTDC participants was developed. The total stud y consisted of 88.1% females and 11.9% males. Age was found to significantly differentiate su ccessful from unsuccessful completers as the majority of participants who successfully complete d treatment were either thirty-seven years of age or older or between 31-36 years old. The racial/ethnic com position of the study sample was, for the most part, either African-America n (N=88, 47.6%) or Caucasian (N=92, 49.7%). 8

PAGE 9

9 Results of the hierarchical logistic regre ssion analyses revealed that drug of choice, extent of prior treatment, and source of social support were significant predictors of successful treatment outcome. Unsuccessful completers were significantly more likely than successful completers to identify marijuana as their dr ug of choice and unsuccessf ul completers were significantly more likely than successful comple ters to report no prior treatment history. In addition, successful completers reported th at they received social support from friends/family/spouse/partner significantly mo re than did unsuccessful completers. Based on our findings more research is needed that examines characteristics associated with successful completion of FTDC programs. In addition, research focused on perceptions of the effectiveness of treatment components is needed and the role of motivation on successful completion. Recommendations were also made regarding the need for further research examining gender differences in referral to FTDC programs, influence of co-occurring disorders on successful outcomes, and the impact of FTDC programs on future involvement of participants in the child welfare system.

PAGE 10

CHAP TER 1 INTRODUCTION Alcohol and drug abuse is a pervasive problem in todays society a ffecting individuals, families, and communities. Research, both past a nd present, have explored both the advantages and disadvantages of traditional substance abuse treatment programs to improve treatment effectiveness and lower the prev alence of addiction. There is now an abundance of literature assessing the effectiveness of voluntary treatment programs, yet few studies have examined the impact of court-ordered treatment progra ms such as drug courts (Rempel, 2001). It was once believed that treatment participants admitted voluntarily were more motivated, and thus more likely to have better treatment outcomes than coerced or court-mandated participants (Belenko, 2002). However, there is now some evidence that court-mandated participants are just as likely to have favorable outcomes (Belenko, 2002). Substance abuse literature has consistently shown that the lo nger a participant spends in treatment the greater their ch ances for a favorable treatmen t outcome (Peters & Murrin, 1998, Lawental et al, 1996, Trone & Y oung, 1996) with some indicating ni nety days of treatment as the minimum for successful treatment outcome s (Brown, 1997; Hubbard et al. 1989). Drug courts have been found to increase retention rates and reduce substan ce abuse compared with other treatment programs (Peters, Haas, & Murrin, 1999). However, there are varying rates of successful completion among program participan ts which may be due to differences in participants characteristics. Drug court partic ipants often vary in criminal status, drug use history, and involvement with soci al service agencies. An exam ination of these variables may help determine which clients are more likely not to successfully complete treatment and which can be therapeutically engaged to the point of successf ul completion. It is unlikely that all program participants will have successful outco mes using the same treatment model or program 10

PAGE 11

design. As Re mple noted: with the recent explos ion of drug courts, it is important for research to identify key characteristics associated with retention am ong court-mandated populations and to develop effective policies to assist those facing a high risk of drop out (Rempel, 2001, p. 89). This study will explore the retent ion rates of participants in a Family Treatment Drug Court program to determine which client characteristic s affect retention rates and at what point do clients drop out of treatment. Identification of th ese factors could facilitate participant retention through the improvement of program structure an d design. Participants with characteristics which have been identified as contributing factor s to dropping out of treatment could be offered treatment services unique to thei r needs at the onset of treatment to increase participant retention. Scope of the Problem Family Treatment Drug Courts (FTDCs) have undergone limited empirical scrutiny in the substance abuse treatment literature. As of April 2006, there were 183 Family Treatment Drug Courts (FTDC) operating in 43 states in the United States and over 100 programs in development. One of the primary goals of Family Treatment Drug Courts is to support families to access, remain in, and successfully complete substance abuse treatment services. Derived from Adult Drug Courts, which are designed to stop th e abuse of alcohol and other drugs and related criminal activity, FTDC participants are involved with substance abuse tr eatment services due to non-criminal issues related to child maltreat ment. However, unlike Adult Drug Courts, successful treatment does not necessarily guarant ee ultimate success in the FTDC context, and the relationship between participants engagement in treatment and other services, treatment success, and family reunification remains an important unanswered question (Worcel, Green, Furrer, Burrus, & Finigan, 2007, p. 18). In a national evaluation of Family Tr eatment Drug Courts (FTDCs) conducted by Northwest Professional Consortium, Inc. (NPC) and funded by the Department of Health and 11

PAGE 12

Hum an Services Substance Abuse and Mental Health Services Administrations (SAMHSA) Center for Substance Abuse Treatment, researcher s examined whether court, child welfare, and treatment outcomes differed for families served through FTDCs as compared to families who received traditional child welfare services. Designed to answer the question whether drug courts worked, and how and for whom they worked, the study focuse d on four FTDCs located in California (San Diego and Santa Clara Countie s), Nevada (Washoe County), and New York (Suffolk County) chosen due to estimates of ade quate sample size and availability of data. The study included the collection of admi nistrative data from court, ch ild welfare, and treatment data sources on a total of 802 FTDC and 1,167 comparison cases. The researchers examined differences betw een drug court cases and comparison cases in child welfare outcomes (such as family reunification and length of time to reunification) as well as in treatment outcomes (such as time spent in treatment and treatment completion) to answer whether drug courts worked (Worcel, et al., 2007). They also looked as participant psychosocial characteristics, their drug court experiences, a nd how both related to outc omes for participants (Worcel, et. al., 2007). Results from this study show evidence of the effectiveness of the FTDC program model on treatment and child welfare ou tcomes associated with statistically and practically significant results, with 55%-60% increases in the length of stay in treatment services for participants, 40%-54% increases in the rates of treatment completion for participants, 14-36% reductions in the number of days spent in out-o f-home placements for children of participants, and 42%-50% increases in the percentage of children reunified with their pa rents (Worcel, et. al., 2007). To confirm these results that FTDCs are e ffective with substance abusing clients, more research is needed. More specifically, resear ch examining the factors that influence drug 12

PAGE 13

treatm ent court success can improve the design and treatment programs and subsequent client outcomes (Butzin, Saum, & Scarpitti, 2002 p. 1616). Copeland & Wayne (1992), examined predicto rs of treatment drop-out for female substance abuse clients. Using a retrospective design, they looke d at the characteristics of 160 women who left treatment less than five days after their admission and compared them with 160 women who remained in treatment longer than five days to answer two questions: In what ways do women who drop-out of treatment differ in term s of socio-demographic characteristics, sexual orientation, and the number of dependent children? and Do the groups differ in terms of drug use treatment history and psychosocial issues such as a hist ory of sexual abuse? (Copeland & Wayne, 2001, p. 884). None of the participants were under legal sanctio n to participate in treatment. The researchers found that women le ss than 25 years of age were significantly more likely to drop out of treatment than were wo men older than 25 years of age; married women were more likely to drop out of treatment than to complete; women who were employed were five times as likely to complete than to dr op-out of treatment; wome n who reported heroin, amphetamines and tranquilizers as their drug of choice were more likely to drop-out than users of alcohol and/or other drugs; women who were in their first substance dependence treatment were more than twice as likely to complete than drop-out; and that wo men with a history of participating in a extensive number of hours of (80+) support groups (AA/NA) prior to treatment admission were more likely to comple te than drop-out of treatment (Copeland & Wayne, 1992). According to the 2005 National Survey on Drug Use and Health, an estimated 22.2 million persons aged 12 or older were classified with substance dependence or abuse with only 3.9 million (1.6 percent of the population) receiving some form of treatment. More troubling is the 13

PAGE 14

fact that Americans m ake up 4 percent of the worlds population, yet, consume 65 percent of the worlds illegal drugs (Gahlinger, 2004). In addi tion, one in four Americans will have an alcohol or drug disorder at some point in their lifetim e (OAS, SAMHSA, 2005). Billions of dollars have been spent combating the problem of addiction; however, despite the costs, services are relatively scarce and often ineff ective (Califano, 2007). According to the U.S. Substance Abuse and Mental Health Services Administration (S AMHSA) only 17 percent of those in need of treatment receive it (OAS, SAMH SA, 2002). Furthermore, available treatment programs have low success rates as few individuals are able to br eak free of their addiction to alcohol and drugs on the first treatment attempt (Califano, 2007). The devastating impact of substance abuse a nd addiction is greatly exemplified in our nations child welfare and protective service sy stems. Many parents who abuse substances neglect or abuse their children as a result of their addiction. Thus it is common for clients in substance abuse treatment to have some involve ment with child protective systems (Howard, 2004). In a survey by the National Center on Ch ild Abuse Prevention Research, 85% of states reported substance abuse as one of the two major problems exhibited by families in which maltreatment of a child or children was suspected (Child Welfare League of America 2007). About three million cases of child abuse are repo rted each year in the United States, and three out of four involve alc ohol-and drug-abusing pa rents (Child Welfare Information Gateway. Retrieved September 26, 2007). Approximately 45 St ates, the District of Columbia, and Guam currently have laws within their child protection statutes that address the issue of substance abuse by parents. Two main areas of c oncern are (1) the harm caused by prenatal drug exposure and (2) the harm caused to children of any age by exposur e to illegal drug activity in the home (Child Welfare Information Gateway. Retrieved August 5, 2007). Furthermore, the U.S. Department of 14

PAGE 15

Health and Hum an Services estimates that over 900,000 children were victims of parental neglect or abuse (DHHS, 2004) and that parental s ubstance abuse is a significant contributor to child maltreatment in between 40-75% of all child welfare cases (Magura & Laudet, 1996; National Center on Addiction and Substance Ab use, 1999). Moreover, children whose parents abuse substances stay in foster care longer a nd have the lowest probability of successfully reunifying with their parents (Green, Rockhill, & Furrer, 2006; Gregoire & Shultz, 2001). The increase of child welfare cases, resulting from substance abusing and addicted parents, has greatly overwhelmed protective service system s. There are nearly 250, 000 child advocates, caseworkers, and judges employed in our nations one thousand state, local, and private child welfare agencies and twelve hundred family cour ts (Califano, 2007). The workers are charged with the duty of dealing with s ubstance abuse in the child welfare system. However, the majority of child welfare systems lack effective substa nce abuse screening and assessment tools, child welfare workers/caseworkers and judges trained in substance abuse, access to appropriate treatment and ancillary services, or adoption/fost er care agencies with the capacity to help children of substance abus ing parents (CASA, 1999). On September 30, 2003, nearly half a million children lived apart from their families in out-of-home care, (Child Welfare League of America, 2006) due to investig ations of abuse and neglect. Professionals involved with the child welfare system often find themselves inundated with the multitude of child abuse and neglect cases plaguing the protective service systems. Some family court judges hear as many as fifty cases in a single day, for which they must assess the circumstances and credibility of the child, parent(s), caseworker, law enforcement officer, and any other witnesses in approximately ten mi nutes (Califano, 2007). Social workers and caseworkers may also find that they are limited in the services they are to provide to families; 15

PAGE 16

such as in-hom e services (Sed lak & Broadhurst, 1996). This ma y result in a smaller proportion of families receiving important services needed for family stability. In addition, some child welfare professionals are only ab le to investigate a third of their cases (Sedlak & Broadhurst, 1996). A 2003 General Accounting Office (GAO) report documented that staff shortages, high caseloads, high worker turnover and low salaries impinge on the delivery of services to achieve safety, permanence, and well-being for children (Child Welfare League of America, 2007). These child welfare/ foster care workers have caseloads of 24-31 clie nts, when the CWLA recommends that a child protective servi ces caseworker responsible for the initial assessment/investigation have no more than 12 ac tive cases per month and that a foster care caseworker have a caseload of 12-15 children per month (Child Welfare League of America 2007). The taxing effect of substance abuse and addi ction on the child welfare system has resulted in countless incidences nationwide of failure of child protective services to adequately and appropriately secure the safety of children. One such case occurring in the State of Florida involved a child, Rilya Wilson. Born Septem ber 26, 1996 to a homeless, allegedly crackaddicted mother, Rilya Wilson became a ward of th e State of Florida soon after her birth, at her mother's insistence and with a court order of placement. The Department of Children & Families awarded custody of Rilya to a family friend of the mother but in April 2000, a Miami-Dade juvenile judge awarded custody of Rilya to her great aunt and gra ndmother. Both caregivers later reported that in January 2001 a woman from DCF t ook Rilya from their home for testing and that they had not seen her since that time. A crimin al investigation into he r disappearance, uncovered negligence on the part of DCF who had not checked on Rilya in months. In fact, Rilya had been 16

PAGE 17

m issing 15 months and DCF waited six days following this discovery to file a report with the local police department. Incidences such as this prompted the Florid a Legislature to mandate that the child welfare system undergo reorganization and move toward s community-based care. Instead of DCF running the system statewide, under community-based care, the system within each DCF district is locally run by institutions within the commun ity. This has led to more collaboration among community agencies and has fostered a team-lik e working relationship between child protective services and substance abuse treatment agencies. Operation at this level also assists in improved coordination of service deliver y to parents and children. The interconnectedness of subs tance abuse and child abuse/ne glect requires that systems collaborate to take on the bewildering problem of addiction. However, there are challenges to such collaborations stemming from the varying perspectives of agencies and agency personnel (SAMSHA, 2004). The substance abuse treatmen t community often views the alcohol and drug abuse of parents, who abuse or neglect their ch ildren, as having a progressive, incurable disease that can be treated (SAMSHA, 2004). However, Child Protective Service workers, much like society as a whole, perceive these parents as ha ving made irresponsible choices resulting in the endangerment of their children (SAMHSA, 2004). Further comp licating interagency collaboration, is the difference in the client serv ed. Child Protective Service agencies seek to ensure the safety of the child (ren), while subs tance abuse treatment workers focus on treating the addicted parent (SAMSHA, 2004). In addition, the staff of each agency operates wi thin particular constraints. Staff in Child Protective Service agencies have defined time lines (usually 18 months) in which they must work in order to prevent children from remaining in out of home placements for long periods of time 17

PAGE 18

(SAMHSA, 2004). This often does not coincide with the treatm ent expectations of substance abuse agencies who view recovery as a long term process, involving m ultiple relapses on the part of the parent (McLellan, Lewis, OBrien, & Kleber, 2000). Furtherm ore, just as Child Protective Service workers find themselves burdened by bur geoning caseloads so too do most substance abuse treatment programs who have waiting lists for parents being referred for treatment services (SAMSHA, 2004). Statement of the Problem Substance abusing parents may be greatly hi ndered in their ability to provide safe and nurturing homes for their children (US Department of Health and Human Services, 1999); and increased stressors such as loss of employment, poverty, and/or illness only serve to exacerbate the problem. Substance abusers are more likely to change jobs regularl y, to be unemployed for long periods of time, and to suffer injuries on the job (Cook & Schlenger, 2004; Alleyne, Stuart, & Copes, 1991). This increases the financial strain of the family which may in turn result in further drug and alcohol abuse. Most child welfare cases invol ve the mother and treatmen t for these women goes beyond substance abuse treatment (Califano, 2007). Many of these women need mental health care, employment, and parenting training (Behnke, Ey ler, Woods, Wobie, & Conlon, 1997) and these services are often unavailable when the mother is amenable to participating in treatment and accepting services (Califano, 2007). Approximately 67% of parent s with children in the child welfare system require substance abuse treatment, yet child welfare agencies are able to provide treatment to only 31% of these parents (C hild Welfare League of America, 2006). Studies show that the majority of children a ffected by parental substance abuse remain in the custody of their parents (Fei g, 1998). However, there has been a growing movement to remove more children from their biological parent s (Califano, 2007) due to the severity of their 18

PAGE 19

addiction and underutilization of tr eatm ent services. This has pr ompted CPS agencies to work harder in connecting parents with substance abuse treatment provide rs with the realization that 75% percent of the mothers who received compre hensive substance abuse treatment had physical custody of one or more children six months afte r discharge from treatment, compared with only 54% of mothers who had custody of any of their children shor tly before entering treatment. (Child Welfare League of America, 2006). Furt hermore, children whose families do not receive appropriate treatment for alcohol and other drug abuse are more likely to end up in foster care, remain in foster care longer, and reenter foster care once they have returned home, than are children whose families do receive treatment (Child Welfare League of America, 2006). This phenomenon, (parents wit hout custody of their child(ren) has resulted in legislation to expedite adoption laws and requirements. As a result, many have courts established more rigid time lines for family reunification. Fa mily Treatment Drug Courts (FTDCs) were developed to answer the call of these initiatives. Modeled after Adult Drug Courts, which arose from the need to combat the problem of jail/prison overcrowding due to arrests of individuals with substance abuse problems, FTDCs were de signed to provide alcohol and drug treatment; wrap-around services supporting substance abus e treatment, assessment, case management; and program coordination to assist s ubstance abusing parents in reunify ing with their child (ren) in a timely fashion. The passage of the 1997 Adoption and Safe Families Act expanded the role of family courts by: (1) establishing a judicial role in decisions about whether and what reunification services are required, (2) requiring earlier and more comprehensive permanency hearings than previously require d (these hearings must be held within 12 months of initial placement, instead of the prior 18-month requirement), (3) setting deadlines for filing 19

PAGE 20

term ination of parental rights pe titions, and (4) establishing rights of foster and adoptive parents to receive notice of, and appear in, juvenile a nd family court proceedings (Hardin, 1998). Substance abuse treatment programs have de veloped various programs over the years to combat the problem of addiction in society. And although formal treatment programs share multiple commonalities in regards to treatmen t modalities and approaches, treatment by no means is homogeneous. Individuals participate in similar formal treatment programs may still have different outcomes. This recognition has resulted in the establishment of alternative treatment programs, such as Family Treatment Drug Courts, to address the growing problem of addiction. Need for the Study A major health concern in treating all substance abuse clients is the high rate of recidivism with relapse rates ranging from 25% to 50% of those admitted for treatment (Hartwell, 1998). Because Family Treatment Drug Courts are a re latively new initiative, there has not been a sufficient period of time to document their results Studies have consistently examined and documented the relationship betw een retention and effectiveness of drug treatment (Rapp, Sigel, Li, Saha, 1998; Deleon, Melnick, Kressel, 1997 ; Erickson, Stevens, McKnight, & Figueredo, 1995) and have found that longer treatment duration may result in more favorable recovery outcomes following treatment completion. However, unsuccessful completion from treatment programs have become more the rule than the exception in most drug treatment programs (Califano, 2007) indicating that th e majority of individuals admitte d to treatment programs, such as FTDCs, do not remain in treatment for a suffi cient period of time to receive maximum benefit. It is essential to determine which client factors may contribute to successful versus unsuccessful completion from Family Treatment Drug Courts. Such information could be used to alter program design and enhance the overall impact of these programs. This information 20

PAGE 21

could also be helpful in deciding on adm ission crite ria for participation in FTDCs. Participants identified at entry to have characteristics that place them at risk for unsuccessful completion may need to receive a different level of care or receive additional serv ices at the onset of treatment admission to decrease their risk of unsuccessful completion. This information could also be useful in designing program structure for each stag e of treatment so that they are more conducive to the individual needs to the participant. Purpose of the Study Substance abuse treatment providers are increa singly held accountable for demonstrating specific outcomes. Programs must be prepared to demonstrate their effectiveness using objectively verifiable outcome m easures (SAMHSA, 2004). Data an alyzing the effectiveness of such programs will provide a valuable opportunity to streamline programs and improve services. If treatment providers are able to pinpoint at admission wh ich program participants are susceptible to unsuccessful discharge, as well as when during the course of their treatment they are most susceptible, providers may be able to redesign participants treatment, the nature of their services and improve outcomes. The relationship between certain demographic and person-centered variables of Family Treatment Drug Court participants and successf ul program completion is under examination. The study seeks to discern which client character istics may result in unsuccessful completion and at what stage of the participants treatment. This study will examine the retention rate of participants and collect demographic informati on (i.e., age, gender, ra ce, and education) to determine if there are differences in participant re tention rates over the cour se of participation in the FTDC program. More specifically, the study will examine the relationship among participant retention in treatment and their reported drug of choice, frequency of use, criminal status at admission, social support, and prior Child Protectiv e Services (CPS) involvement. In addition, 21

PAGE 22

relationships am ong number of positive drug screens or relapses of the FTDC participants and their continued involvement in tr eatment will also be examined. Theoretical Framework The theoretical framework for this study is informed by the Transtheoretical model developed by Prochaska and DiCl emente (1992). Knowledge of the substance abusing persons motivational state and the factors leading to it ca n help guide the development of more effective interventions. Motivation and readiness are vi ewed by clinicians as critical factors in understanding why substance abusers seek or stay in recovery oriented treatment. A challenge for many individuals dealing with alcohol and drug abuse is the inconsistency that often exists within them regarding their r eadiness to change. Indi viduals may continue to abuse alcohol and drugs despite experiencing nega tive consequences (i.e., jail, unemployment, illness). Researchers have found that this incons istency is natural and should be expected, as formal substance abuse treatment programs stress th at relapse is part of th e recovery process. Miller and Rollnick (2002) found that substan ce abusers often recogni ze the risks, costs, and harm involved in their beha vior. However, these individuals are often in a state of ambivalence regarding the need to change. According to the authors, this state of ambivalence is a natural phase of the change process. But, th e problem may persist and intensify if individuals become stuck in ambivalence (Miller & Rollnic k, 2002). For example, while regaining custody of ones child is a powerful incentive for many parents, those addicted to drugs like crack cocaine, methamphetamine, and alcohol may often be more driven to get high or drink than to recover their children (Califano, 2007). The Transtheoretical theory portrays the se quence of changes indi viduals progress through as they initiate and maintain behavior change. They derived 10 distin ct processes individuals experience while recovering from alcohol and dr ug abuse that occur within five stages. 22

PAGE 23

According to the m odel, as individuals replace high -risk behaviors, such as substance abuse, with healthier alternatives they move through fi ve stages of change: precontemplation, contemplation, preparation, action, and maintenance (Abellas & McLellan, 1993). The first stage, precontemplation, is the state of unawareness of the pr oblem or a need to change (Miller & Rollnick, 1991). Individuals who present in th is stage have no intention to change the behavior. As awareness of the problem increases, the individual enters a state of ambivalence or contemplation, in which the individual begins to asse ss the problem behavior (Miller & Rollnick, 1991). The individual begins to consider change but has not made a firm commitment. As they begin to weigh the pros and cons of the behavior the individual begins to see the necessity of change and enters the preparation stage of change. Following this transition, the individual moves into an action stage in which efforts are made to cha nge the behavior. If these efforts are successful, the individual moves into the maintenance stage which involves relapse prevention (Marlatt & Gordon, 1985). An individuals motivation to make change and participate in substance abuse treatment may influence the probability of them remaining in treatment for a long enough period of time to benefit from exposure to the therapeutic pr ocess (Gossop, Stewart, & Marsden 2007) and increase the likelihood of positive treatment outcome s. The Transtheoretical model, in clinical settings, emphasizes the need for different t ypes of treatment and s uggests that different interventions are required at th e varying stages of change (M iller & Rollnick, 1991) to promote continued participation and treatment compliance. Treatment compliance can be described as following the instructions and requirements of th e treatment, such as; attending a certain amount of treatment sessions, abstinence from drugs/alcoh ol, submission to urine screens, and attendance of support groups (Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous) 23

PAGE 24

(Diclem ente & Scott, 1997). These are all observable and measurab le events used to determine if the individual has been exposed to the appropriate dose of treatment believed to be necessary for change (Diclemente & Scott, 1997). Dose of treatment has been associated with compliance as researchers have found that retent ion and completion of treatment yields better outcomes (Stark, 1992; Anglin & Hser, 1992). Strategies and interventions used to promot e change differ significantly across the stages (Diclemente & Scott, 1997). Therefore, it is important to match the treatment with the individuals stage of change. Stage-based matching of interventions offers a dynamic, processoriented approach for developing appropriate treatment expectati ons and shared mutual goals on the part of the therapist and the client ((Diclemente & Scott, p. 146). The ideal is sequencing and shifting treatment goals as the client progr esses through the process of change (Diclemente & Scott, p. 147). The Family Treatment Drug Court under study has used the Transtheoretical model and treatment matching in the design and st ructure of their program. The program is structured into four distinct phases of interven tions designed to mirror the type of intervention required for each stage of change of the model. For example, individuals coming into substance abuse treatment are often in early stages of the Transtheoretical model, a time associated with high dropout rates in treatment programs (particularly outpatient) (Wic kizer, Maynard, Atherly, Frederic k, Koepsell, Krupski, & Start, 1994; Emrick, Tonigan, Montgomery, & Lit tle, 1993). It is in the stage of pre-contemplation that individuals show marked unawareness of a problem and one is exposed to concepts, such as denial. As a result, interventions in early stages of the change process must address the lack of motivation for change, ambivalence about change, and lack of a clear problem focus (Diclemente & Scott, 1997). Conscious-rais ing interventions, such as conf rontations, observations, and 24

PAGE 25

interpretations, have been found to assist individuals in gaini ng awareness of their problem and from moving from pre-contemplation to contemplation (Norcross & Goldfried, 2005). Phase I of the Family Treatment Drug Court requir es participants to report to court weekly and attend treatment sessions four days a week (3 hour sessions) where they participate in more educational groups, such as the Disease Model of Addiction and pharmacology. This is intended to move the participant out of a state of unawareness of their s ubstance abuse problem and into contemplation. Participants are also requi red to attend a minimum of 2 support group meetings each week, such as AA (Alcoholics Anonymous) a nd/or NA (Narcotics Anonymous) to continue to increase their exposure to the therapeutic process of treatment, increase observation of others suffering from the disease of addiction, and foster retention. As participants begin to make the shift to awareness they are requ ired to obtain and begin work with an AA or NA sponsor, the final requirement of Phase I. Participants in Phase II of the program have reached preparation, via their acknowledgement and acceptance of their need to change. Movement from pre-contemplation to contemplation and movement through the contemplation stage, involves increased use of cognitive, affective, and evaluative processe s of change (Norcross & Goldfried, pg. 150). Participants at this stage are perceived as ha ving more motivation and readiness for behavior change. As a result, interventions become more self-evaluative. An intervention used at this Phase of the program includes writing ones autobiography which includes milestones, life events, and patterns of drug use. Participants are asked to refl ect on their history and process patterns of thinking, feeling, and be having. Participants moving through contemplation, in to Phase II of the Family Treatment Drug Court prog ram, have also attained a required period of abstinence (60 days minimum) and are monitored le ss frequently. Participants are required to 25

PAGE 26

report to cou rt bi-weekly and treatment session attendance decreases to three days a week. Participants continue to attend educational gr oups but also begin more therapy groups. In addition, participants are encouraged to deve lop sober support systems outside of treatment which requires them to continue work with th eir sponsor and increase support group meeting attendance to 3 meetings each week. Preparation indicates a readiness to change in the near future and acquisition of valuable lessons from past change attempts and failures (Norcross & Goldfried, pg. 150). It is important at this point for individuals to begin to set goals and an acti on plan for the future (cite). Interventions, at this stage in the Family Treatment Drug Court involve relapse prevention planning and are designed to assist participants with self-regulati on to continue behavior change. Participants attend groups on rela pse prevention and are required to develop their own relapse prevention plan. Prevention planning will contin ue throughout the duration of their participation in the program. As participants continue to make change, reaching action, they are moved to Phase III of the program. During the action stage, it is important that clie nts act from a sense of selfliberation (Norcross & Goldfried, pg. 150). Partic ipants are assisted in developing the belief that they have the autonomy to change and in fostering a sense of self-efficacy (Norcross & Goldfried, 2005). Monitoring of participants decreases further to attending treatment to two days a week, while support group attendance increases to f our days a week. Participants continue to cognitive, affective, and behavioral capacity to cope with external circumstances which may contribute to their substance abuse. Participants work more clos ely with their sponsor, continue to meet case plan tasks of the CPS agency, and ta ke part in interventions which involve training in behavioral processes. Part icipants typically continue in action through Phase IV of the 26

PAGE 27

program to maintenance where relapse prevention interventions are intensified. Participants in Phase IV attend treatment sessions once a week, c ontinue to work with their sponsor, and attend support group meetings 5 times a week. Relapse and recycling are an integral part of the process of change (Diclemente & Scott, p. 147), therefore, participants may move through the stages in a cyclical pattern throughout their participation in treatment. It is not uncommon for Family Treatment Drug Court participants to move back to previous phases of the program as relapses and/or treatment non-compliance occurs. Some participants may repeat a phase of the program multiple times and for a longer duration than others. Furthermore, participants who struggled (i.e. multiple relapses) in early phases of the program may be recommended to rema in in Phase IV of the program for a longer period of time to assess their ability to maintain their current stage of change before they are successfully discharged from the program. Due to the evolving na ture of stage of change, patterns of regression will not be under examinati on. The participants phase of treatment at the time of program discharge will be included in the data for the study. Hypotheses By means of an archival analysis of the c linical records of participants of a Family Treatment Drug Court program this study will examine variables related to successful completion from treatment. These variables are (1 ) participants drug of choice, (2) participants frequency of drug use (3) particip ants prior treatment history, (4) participants criminal status, (5) participants social support, (6) participant s prior Child Protective Service involvement, and (7) successful completion rate. The following (seven) hypotheses will be tested in this study: Ho1: There is no contribution to the prediction of successful completion of Dependency Drug Court of participants drug of choice, frequency of drug use, treatment history, criminal status, sources of social support, and involv ement with Child Protective Services. 27

PAGE 28

Ho2: There is no relationship between succe ssful completion of Dependency Drug Court and participants drug of choice. Ho3: There is no relationship between succe ssful completion of Dependency Drug Court and participants frequency of drug use. Ho4: There is no relationship between succe ssful completion of Dependency Drug Court and participants treatment history prior to program admission. Ho5: There is no relationship between succe ssful completion of Dependency Drug Court and criminal status of the participant at time of program admission. Ho6: There is no relationship between succe ssful completion of Dependency Drug Court and sources of social support among particip ants at time of program admission. Ho7: There is no relationship between succe ssful completion of Dependency Drug Court and participants prior involvement with Child Protective Services. Definition of Terms Arraignment At this hearing, the parent or legal cu stodian admits, denies, or consents to the findings alleged in the dependency petiti on. If the parent admits or consents, a disposition hearing must be held within fifteen (15) days of the arraignment. If the parent or legal custodian denies th e allegation, then a dispositi on hearing must occur within thirty (30) days of the arraignment. Case plan A case plan is a written document that e xplains the reasons why the child is considered in need of protection, the goa l of the ongoing interven tion, and the outcomes and actions required to achieve the goal. The pl an will detail: (1) the steps the client must take and the terms and conditions he/she must meet to retain or regain custody of the child (ren), (2) a timetable for accomplishmen t of each step, term, and condition, and (3) a list of resources the CPS agency will make available to the parent. Child protective investigator. Receives, screens, evalua tes, and investigates referrals/complaints relative to alleged child ab use and/or neglect and alleged institutional 28

PAGE 29

abuse and/or neglect; to take the necessary m easures to ensu re the protection of children; and to do related work as required. Child protective service involvement. The number of prior open child protective service cases prior to entry into the drug court program. Criminal status. The individuals self-report of curre nt and previous involvement with the criminal justice system, such as no hist ory of criminal involvement, not under legal supervision but at least on e previous criminal charge, and currently under legal supervision. Disposition order. Dispositional orders may vary. A child may be placed in foster care until completion of the first permanency heari ng which will be stated in the dispositional order. Some dispositional orders may place th e child in foster care granting the agency authority to parole or discharge the child to the parent at some later point and in some cases a dispositional order may release a child to a parent. For noncompliant respondents, dispositional orders will likely place the children in foster care. Drug court A process by which substance abusers entering the court system are placed into treatment and proactively monitored by the judge and a team of justice-system professionals; it employs effective drug testi ng and graduated sanctions and incentives. Drug of choice. Self reported drug most preferred or most used by an individual. Family treatment drug court assessment. Evaluation designed to assist individuals in determining to what degree a client has a subs tance abuse problem, and what treatment, if any, would be clinically appropriate. The a ssessment may consist of assessment testing using nationally validated screening tools, (Substance Abuse Subtle Screening Inventory, SASSI-3, DSM-IV and the American Society of Addiction Medicine Diagnostic Criteria 29

PAGE 30

for Substance Abuse and Dependence). Inform ation in a number of areas is gath ered; including family background, social history, legal history, medi cal history, mental health history and substance use hi story and patterns. The eval uation also assesses client responses and reactions. Frequency of use. The self-reported pa ttern of drug/alcohol use of drug court participants. Pre-court staffing. Meeting held prior to the FTDC hearing involving the Judge, CPS workers, substance abuse provider, court ad ministrator, CWLS attorney, Guardian Ad Litem representative in which progress of the program participants is discussed. Referral (packet). A referral (packet) includes a copy of the most recent Abuse Hotline Information System Report bringing the client to the courts atten tion, copies of prior investigation reports, a copy of the dependency emergency shelter petition if removal of child occurred, an initial assessment comple ted by the assigned CPS service worker, a mediation agreement if applicable, a draft or finalized case plan, and any other legal, department, or agency information re levant to the clients treatment. Reunification (permanency). Reunification of the child with the parents which must be reached within twelve (12) months. Shelter hearing A hearing held within 24 hours of a childs removal from their home, excluding weekends and holidays to determin e placement of the child because a parent, custodian, or guardian is unavailable to take immediate custody of the child. Social support. The support an individual receives fr om family, friends, spouse/partner, and institutions (i.e., employmen t, church, support groups). 30

PAGE 31

31 Substance abuse. Long-term, pathological use of alcohol or drugs, characterized by daily intoxication, inability to re duce consumption, and impairment in social or occupational functioning; broadly, alc ohol or drug addiction. Successful completion. Criteria for successful completion include: (1) remaining clean and sober, (2) fulfilling all drug testing requirements, (3) attending all required AA/NA meetings, treatment sessions, and court sessions, (4) employment or working on educational/vocational plan, and (5) completi ng all of the goals of the drug treatment plan. Termination of parental rights. The complete severance by court order of the legal relationship, with all its right s and responsibilities, between child and his/her parent or parents so that the child is free for adoption. Treatment history. The self-reported frequency and t ype of substance abuse treatment received by an individual prior to entry into the drug court program (outpatient, intensive outpatient, and/or inpatient treatment). Treatment stage. The current placement of the partic ipant in the drug court programs stages of program completion (Pha ses I, II, III, and IV). Overview of Remainder of Study The remainder of this study consists of four ch apters. Chapter 2 provide s a review of related literature. Chapter 3 contains a descripti on of the procedures for the study; including methodology and research design. The results of the study will be presented in Chapter 4. Chapter 5 will include a discussion of the results, conclusions, implications, limitations, and recommendations for further research.

PAGE 32

CHAP TER 2 LITERATURE REVIEW This literature review will examine the ex isting body of knowledge related to drug court programs, more specifically Family Treatment Drug Courts. First a brief overview of traditional substance abuse components will be provided, followed by a disc ussion of the development of Adult Drug Courts and Family Treatment Drug Courts. A full description of the program components of the Family Treatment Drug Cour t program under study will also be provided, followed by a discussion of the variables included in the study: (1) drug of choice, (2) frequency of drug use (3) prior treatment hi story, (4) criminal status, (5) social support, and (6) prior CPS involvement. There are various treatment models used to address alcohol and dr ug abuse but the most widely emulated approach to substance abuse treatment is the Minnesota Model developed by the Hazelden Foundation, which is an abstinence -oriented, multi-professional approach based on the principles of Alcoholics Anonymous (AA). The Hazelden Foundation is a national nonprofit organization founded in 1949 that provides addiction treatment for alcohol and other forms of drug abuse. Substance abuse treatment is administered in a variety of ways including outpatient, inpatient and detoxification set tings. Drug court programs may in corporate any number of these treatment settings in the rehabilitation of its participants. Intensive outpatient programs are usually held for 3-4 days each week for 2-4 hour s each day, while outpatient treatment entails less frequent contact (1-2 days a week and shorte r 1-2 hours per session). Inpatient or residential programs vary in length; however, typical program s are 28 days or less. They involve 24-hour supervision, a total immersion in treatment, and are highly struct ured. Detoxification programs are inpatient settings in which clients are mon itored by medical staff as they withdraw from 32

PAGE 33

drugs and alcohol. They m ay or may not be pr ovided medication to as sist with withdrawal symptoms. However, the past few years have se en a major shift to outpatient detoxification, organized outpatient treatment programs (both evening and day), office care, and referral to Twelve-Step self-help treatment (Alterman, McClellan, OBrien, August, Snider, Droba, Cornish, Hall, Raphaelson, & Schrade, 1994). Treatment encompasses individual therapy, gr oup therapy, family therapy, support groups (such as Alcoholics Anonymous and Narcotics Anonymous), and medication. Group therapy constitutes the most commonly applied modality for the treatment of alcoholism and other substance abuse (Golden, Khantzian, & McAuliffe 1994). In fact, group therapy is frequently regarded as the psychotherapeutic treatment c hoice for addicted individuals (Matano & Yalom, 1991). Adult Drug Courts Circuit Court Judge Herbert Klein is credited with establishing the first drug court program in Miamis Dade County in an effort to divert nonviolent offenders to mandatory and intensive treatment programs which would address substa nce abuse issues (Belenko, 2002; Cooper, 2000). The necessity of this program arose in response to a growing problem with crack cocaine in the late 1980s resulting in jail overcrowding (Report on Florida Drug Courts, 2004) and in response to the high rate of recidivism among substan ce abuse individuals (Ful ton Hora, 2002). Prior to the development of drug court, criminal courts would sentence drug offenders to jail for short periods of time in an attempt to manage the growing number of inmates. However, this alternative did little to resolve the problem of drug abuse among offenders and prevent the revolving door of drug abuse offenders returning to jail (Report on Fl orida Drug Courts, 2004). After enlisting the help of key figures such as State Attorney General Janet Reno, Public Defender Bennett Brummer, and other community leaders, a team approach emerged to address 33

PAGE 34

offender recovery aim ed at habilitation/rehabi litation through intensive court monitoring. Drug courts offered court-supervised treatment to low-level drug offenders and first-time drug offenders as a means to reduce the number of incarcerated individuals with substance abuse disorders, while others target ha bitual offenders (Pearce, 1999). Th ese specialized courts seek to prevent incarceration and facilitate community-based treatment for offenders, while at the same time protecting public safety. This newly developed Drug Court program, following a diversion model of treatment, worked with defendants at the pre-sentence stage of the judicial proce ss and included periodic drug testing, ongoing judicial supervision, sanc tions and incentives, a nd close monitoring. The majority of Drug Court programs today follow this same method wherein, if defendants complete the program requirements, criminal charges ag ainst them are dismissed (Belenko, 2005). Drug courts also can be held post-sentence, wher ein drug court program graduates receive reduced probation sentences or avoid incarceration (Belenko, 2005). As of 2002, a total of 1,238 drug courts were ope rational or in the planning stages of development within all 50 stat es; including the District of Co lumbia, Puerto Rico, and Guam (Cooper, 2000). Tribal Courts were also developed among Native American communities and currently there are 14 states which contain Na tive American Tribal Courts (Cooper, 2000). Based largely on the U.S. model, drug courts have also been developed in Australia, Canada, and Great Britain and are in the plan ning stages in Brazil and severa l other countries (Turner et al., 2002). One of the most positive aspects of drug cour ts is that they serve a large population of individuals who may not have ha d an opportunity or access to treatment services due to unique circumstances and socio-cultural experiences. One review of drug courts found, for example, that 34

PAGE 35

25 percent of participants were fem ale, 48 percen t were racial minoritie s, 74 percent had prior felony convictions, 49 percent were unemployed at the time of arrest, 76 percent had undergone prior failed drug treatment, 20 percent had at tempted suicide, and between 15 percent and 56 percent reported past sexual or physical abuse (Belenko, 2002). Drug courts provide access to an array of community treatment and support services that may not otherwise be available to their participants. A survey of drug court treatment found that the vast majority of drug courts offered participants outpatient treatme nt, access to Alcoholics Anonymous and Narcotics Anonymous support groups, mental health treatment, relaps e prevention, educational and vocational training, and residential services (Peyton & Grossweiler, 2000). Family Treatment Drug Courts The success of Adult Drug Courts served as the impetus for the development of Family Treatment Drug Courts (FTDC) to address ch ild abuse and neglect cases resulting from substance abuse by parents. FTDCs are speciali zed programs designed to help bring parents and their children back together. These programs are designed to serve individuals who have been charged with child neglect and in which alcohol and/or substance abuse allegations have been made. The goals are to help these participants recover from alcohol or substance abuse and to work toward reuniting pare nts with their children. Research findings suggest that interven tions aimed at ending substance abuse and addiction cycles, child abuse and neglect, and child maltreatment are more successful when they are family centered (Magura & Laudet, 1996). Acco rding to Margura & Laudet (1996), services which are critical for the substance abusing pa rent include: (1) access to physical necessities, such as food, housing, and transportation, (2) me dical care, (3) counsel ing on substance abuse prevention, (4) training on parenting and child deve lopment, (5) social services, social support, psychological assessment, and mental health ca re, (6) family planning services, (7) family 35

PAGE 36

therapy and health education, (8) life skills training in such areas as financial m anagement, assertiveness training, stress management, coping skills, home management, anger management, conflict resolution, and communicat ion skills, (9) educational and vocational assessment and counseling, and (10) planned, c ontinuing care after program comp letion. Given the widespread need of services for such parents, a team a pproach is often essential when child protective service agencies are involved (Howard, 2004). A Family Treatment Drug Court (FTDC) is defined as a drug court that deals with cases involving parental rights, in whic h an adult is the pa rty litigant, which co me before the court through either the criminal or ci vil process, and which arise ou t of the substance abuse of a parent and deal with custody a nd visitation disputes; abuse, neglect, and dependency matters; petitions to terminate parental rights; guardians hip proceedings; or other laws, restriction, or limitation of parental rights (Cooper & Bartlett, 1998). The proportion of child abuse and neglect cases involving substa nce abuse has grown significantly in recent years (Goodman & Harrell, 1999). FTDCs are designed to handle the needs of this population. The Family Treatme nt Drug Court's case management unit has the ability to quickly identify and link addicted pa rents charged with negl ect to appropriate drug treatment programs. FTDC monitors compliance, responds to progress a nd/or problems through graduated sanctions/rewards, establishes cooperation and communication among agencies involved in the reunification pro cess, assures all information is up-to-date and comprehensive and ultimately seeks to speed the entire court pr ocess, enabling the children to return more swiftly to recovered parents or achieve other permanent homes. Proponents of Family Drug Courts hope that the authority of the courts can be used to in crease the effectiveness of child welfare agencies by expanding access to alcohol and drug treatment, increasing pressure on 36

PAGE 37

parents to ad dress their substance abuse problems, and coordinating the multiple social services needed to stabilize many of these families (p. 2, Goodman & Harrell, 1999). The first FTDC began in 1994 in Reno, Nevada (U.S. Department of Justice, 2004). A 2004 publication by the National Drug Court Ins titute and Center for Substance Abuse Treatment chronicles the gather ing of four Family Treatment Drug Courts from across the country (Kansas City, Missouri; Reno, Nevada; San Diego, California; and Suffolk County, New York) in 1999 in which practit ioners discussed their implem entation and experiences with FTDCs. Participants of this 2-day focus group explored the pros and cons of various approaches to the development and operation of FTDCs, formulated a mission and overall goals for the court, and took the first steps toward de vising a national strategy for advancing the FTDC concept (U.S. Department of Ju stice, 2004; p. 4). At the time of this focus group there were 10 FTDCs in operation around the co untry, with approximately 10 more in the planning stage (U.S. department of Justice, 2004). Participants of this focu s group identified several key characteristics shared by the FTDCs; which included (U.S. Depa rtment of Justice, p.12 2004): An integrated focus on the permanency, safety, and welfare of abused and neglected children with the needs of the parents. Intervening early to involve parents in developmentally appropriate, comprehensive services with increased judicial supervision. Adoption of a holistic approach to strengthening family functioning. Individualized case planning based on comprehensive assessment. Ensuring legal rights, advocacy, and conf identiality for parents and children. Scheduling regular staffings a nd judicial court reviews. Implementing a system of gradua ted sanctions and incentives. 37

PAGE 38

Operation w ithin the mandates the Adopti on and Safe Families Act (ASFA) of 1997 and the Indian Child Welfare Act of 1979. Reliance on judicial leadership for both planning and implementing the court. Making a commitment to measuring program outcomes. Planning for program sustainability. Striving to work as a colla borative, non adversarial team supported by cross training. Family Treatment Drug Court Process Each state has a child protective services (C PS) system to investigate reports of child abuse, neglect, and maltreatment to determine whet her the child in question is at risk. After an abuse report has been made, the CPS agency ini tiates a comprehensive assessment of the childs safety and well-being in the family. This asse ssment may include interviews with the child, the parents, and other family member s; visits to the home to eval uate the environment and family dynamics; contacts with schools and other service providers who are or have been involved with the family; and testing to assess the childs health and development (Kropenske & Howard, 1994). If the CPS agency determines that the child is, or is at ri sk of being, neglected or abused, they may initiate family preservation services (see Figure 1.1). Parents may go through multiple hearings whil e involved with CPS, and although Family Treatment Drug Court processes vary widely according to state and jurisdiction, there are generally seven different types of hearings in child welfare (Badeau, retrieved October, 7, 2007) summarized as follows: Permanency Hearing: To determine whether the child should be placed in emergency, temporary out-of-home care. Adjudicatory Hearing: To determine if abuse or neglect did, in fact, occur. Dispositional Hearing: To determine where the child in fost er care will live, who will have custody of the child, and what conditions wi ll be placed on the agency and parents. 38

PAGE 39

Periodic Review s: To review progress under th e childs case plan. (These reviews must occur at least every six months). Permanency Hearing: To approve a clear, definitive permanency plan for the child. (The hearing must occur within 12 months of the childs initial placement.) Termination of Parental Rights Hearing: To determine whether the pa rent(s) rights should be terminated. With some exceptions, federal law requires states to initiate this proceeding for any child who has been in foster care for 15 of the last 22 months. Adoption of Guardianship Hearing: To make the child legally part of another family, either through adoption of by establishing legal guardianship. If it is determined that the child is not safe in the home, the CPS agency has the authority to remove the child and place them in an alternativ e living situation, such as foster care or with a relative. In 1996 few children we re removed from their homes and placed in foster care, representing only 16 percent of CPS cases (U.S. Department of Health & Human Services, 1999); however, the increase of pervas iveness and severity of substa nces today has resulted in an increase in foster care placements. In a 2005 National Association of Counties survey, 40% of child welfare officials reported in creases in the number of children placed in foster care due to parental methamphetamine use in the past year (National Association of Counties, 2005). In addition, data indicates that a bused and neglected children from substance abusing families are more likely to be placed in foster care and ar e more likely to remain there longer than are maltreated children from non-substance abusing fa milies (U.S. Department of Health & Human Services, 1999). Program Structure (Adapted from the Policies and Procedures Manual (2006) for the Dependency Drug Court in the Eighth Judi cial Circuit, Alachua County, Florida) The Family Treatment Drug Court, k nown as the Dependency Drug Court (DDC) Program in Alachua County, is a partnership between the Judicial Circuit Court, the Department of Children and Families (DCF), Partnership for Strong Families, Child Welfare Legal Services, 39

PAGE 40

defense attorneys, Guardian Ad Litem, and tr eatm ent providers. Participation in the DDC program is court ordered, and the average length of treatment in the program is 10-12 months. The goal of the DDC program is to provide immedi ate treatment and support to parents to assist them in maintaining abstinence from alcohol/drugs and to assume, as soon as possible, total responsibility for parenting their children. Judicial Role The Dependency Drug Court Judge is responsib le for the supervision and management of the DDC program. The Judge establishes a rehabili tative relationship with the parents, with the goal of providing a supportive and th erapeutic environment for all of the participants. The Judge chairs the pre-court case status conference held prior to each session of Dependency Drug Court to review the progress of the parents. Each week, the Judge reviews with the pa rent, their progress in meeting objectives outlined in their treatment plan/case plan. Th e Judge provides praise for parents who are in compliance with case plan goals, as well as, en couragement and consequences/sanctions to motivate parents who are not in compliance. To encourage compliance, the Judge may use both positive and negative incentives and may assume the role of task master, mentor, or confidante. Drug Court Coordinator The Drug Court Coordinator prov ides the link between the Court, attorneys, Department of Children & Families, parents, and the treatme nt provider. Responsibilities include; (1) Attendance at Shelter Hearings a nd provision of assistance in the referral process, (2) meeting with parents and attorneys to provide them with information regarding DDC (3) preparing all of the paperwork including the Order to Participate in the DDC and providing them to the Judge and attorneys, (4) attend ing staffings, (5) attending weekly DDC hearings, (6) advising the DDC 40

PAGE 41

Judge and other Drug Court Team members of a ny issues and concerns regarding the Program, and (7) providing training to Judges, atto rneys, and agencies of the DDC program. Guardian Ad Litem The Guardian Ad Litems responsibilities are to : (1) attend weekly DDC pre-court staffings, (2) attend weekly DDC hearings, (3) provide relevant information regarding the childrens progress to the DDC team, and (4) assist the DDC program by contacting the DDC Coordinator if in the course of his/her duties the Case Coordinator ha s reason to believe that a parent may be an appropriate candidate for a DDC assessment. Department of Children & Family Attorney The attorney for the Department of Children & Families (DCF) represents DCF in DDC cases throughout the legal process. This representation includes helping to identify cases that meet the criteria for DDC; ensuring that there is a corresponding legal dependency case with a case plan goal of reunification; negotiating with lega l counsel for the prospective DDC client; and ensuring all necessary lega l documents are properly execut ed and forwarded to the DDC coordinator. Once a case is accepted into the DDC program and a court order is signed ordering the client into DDC, the DCF attorney continues to represent DCF in all cour t proceedings including arraignments, disposition and adopt ion of the case plan and subseque nt judicial revi ew hearings. The DCF attorney participates in the weekly pre-court case stat us conferences with the judge, prepares all court orders for the Courts c onsideration and attends the weekly DDC court hearings. If a DDC client is non-compliant w ith the terms and conditions of the DDC program and the team recommends discharging the client from the program, the DCF attorney prepares an order for the courts consideration dischargi ng the client and, when appropriate, files a 41

PAGE 42

term ination of parental rights pe tition or a case plan reflecting some other permanency goal for the children of the DDC client. Family Care Counselor for Depar tment of Children & Family The Family Care Counselor (FCC) identifies and assesses the clients needs, familys needs and the needs of the minors placed in th e care of DCF due to abuse or neglect by caretakers, with the ultimate goal of permanen cy. The FCC is responsible for compiling the referral packet information need for the treatm ent provider to complete the DDC assessment on a prospective DDC program client. The FCC is al so responsible for evaluation, coordinating, and ensuring necessary services are provided to the pa rent. These recommendations are compiled in the parents case plan, or service plan, and may cover housing, day care, transportation, clothing, food stamps, parenting training, individual or group counseling (including substance abuse treatment), and teaching the parent basic household skills (Howard, 2004). In addition, the FCC will ensure that the DDC team is update d on the clients progress in addressing case plan tasks, and providing any information that would assist the treatment provider in providing treatment services to the parent. Substance Abuse and Mental Health (SAMH) Liaison : The SAMH liaison is responsible for maintaining the DDC program budget, and providing a weekly report on the cost incurred. The SAMH Liaison is also responsible for maintaining information on all substance abuse refe rrals made to SAMH providers. If residential services are required for the progr am participant, the SAMH Liai son is responsible for providing the financial impact of admitting a client who requires residential services at the weekly case status conference. 42

PAGE 43

In addition, the SAMH Liaison is responsible for ensuring all agency partners are aware of the established outcomes for the DDC Progr am and reporting quarterly on the documented performance. The SAMH Liaison will also review, with the DDC team, strategies for improving performance when warranted. Substance Abuse Clinician The treatment providers staff is responsible for providing direct clinical se rvices to participants in the DDC program through individual, group and family therapy sessions. The clinician will provide an assessment, treatment plan, referral services and docu mentation of the DDC parents progress. The clinician is responsible for explai ning program expectations, rules, confidentiality, client rights, and phase requirements to DDC pa rents. In addition, he/s he is responsible for obtaining the parents signature on the agr eement to participate in the DDC program. The clinician provides progress reports to the Judge and DDC team for all parents participating in the program at weekly staff hearings. Reports will include; (1) progress made towards treatment goals, (2) barriers to treatment for clients, (3) specific issues that need to be addressed that might assist with or impede phase changes, (4) compliance and attendance, (5) results of drug testing and breathalyzer, (6) non-compliance with submitting to drug testing and/or breathalyzer testing, (7) compliance with attending 12 St ep meetings, obtaining a sponsor and meeting with their sponsor, (8) recommendations for sanctions for non-compliance issues that might enhance the clinical pr ogress, (9) referrals for needed Case Management services, (10) referrals for other professional services (Domestic Violence, A nger Management, Mental Health, etc.), (11) feedback on referrals to the DCF Liaison, Family Care Counselor, and DDC Coordinator, and (12) information on referrals and outcome measures. 43

PAGE 44

Eligib ility Criteria for Dependency Drug Court Clients Below are the criteria considered when a pros pective program participant is referred to the Dependency Drug Court program: Parent/Guardian must have a child removed and sheltered due to concerns about the parents/guardians alcohol and/or substance abuse. Parent/Guardian must have a child adjudica ted dependent and be in jeopardy of having parental rights terminated as a result of the pare nts/guardians inability to stop using alcohol and/or drugs. Referral Process The Dependency Drug Court coordinator is responsible for attending all dependency shelter hearings, to identify prospective DDC prog ram clients. If the shelter petition is granted, the parent(s) are ordered to complete a Dependency Drug Court Assessment immediately following the hearing. Prospective DDC program clients may also be identified by the Child Protective Investigator, Child Welfare Legal Serv ices Attorney, Guardian Ad Litem, Defense Attorney, and Treatment provider staff working w ith a DCF client. Once identified, the referral source is responsible for forwarding all relevant client informati on to the Department of Children and Families. Variables under Study Drug of Choice and Frequency Primary drug of choice is defined as the self-re ported drug most preferred or most used by an individual. Researchers ofte n look at this variable becaus e type and frequency of drug use are important factors related to treatment retention and outcome Some researchers have found significant differences in treatment success rate s of clients based on type of drug used and 44

PAGE 45

frequency of use. Schiff and Terry (1997) c onducted a study of Florida Drug Treatm ent Court participants in which they limited eligibility to participate in th e study to offenders arrested for drug-related offenses involving cocaine. Accordi ng to Schiff and Terry (1997) crack cocaine use was found to be significantly and negatively rela ted to completion of the drug treatment court program. They suggest that because crack cocaine is highly addictive, the use of this particular drug was an important factor in preventing offenders from successful completion (Schiff & Terry, 1997). A drug treatment court study conducted in Delaware also looked at completion and noncompletion of participants and f ound crack cocaine to be a predictor of treatment failure when compared to non crack cocaine-usi ng participants (Saum, Scarpitti, & Robbins, 2001). Peters, Haas, and Murrin (1999) also found that clients who reported cocaine as their drug of choice graduated at a lower rate than those who reporte d alcohol or marijuana as their primary drug. Furthermore, research indicates that multip le substance use increases the likelihood of unsuccessful completion (Logan, Williams, Leukefeld, & Minton, 2000). In this study, the relationship between drug(s) of choice and rate of successful completion will be examined for Family Treatment Drug Court participants. Frequency of use will also be examined to determine whether frequency of use prior to admission has an effect of participant retention and completion of treatment. Prior Treatment It is not uncommon for an individual to go through multiple treatment episodes in the course of their history of drug a nd/or alcohol abuse due to the rela psing nature of addiction. As a result, multiple treatment admissions are often viewed by treatment professionals as a common occurrence of recovery rather than failed efforts to maintain sobriety (Longshore & Prendergast, 1997). Clients may exhibit different treatment outcomes over the cour se of their drug history and 45

PAGE 46

prior treatment experien ces may affect their curre nt participation in treatment, which in turn, may influence treatment outcome s (Longshore & Prendergast, 1997). Substance abuse treatment is oriented to th e process of recovery from addiction, based upon a model of addiction as a chronic, relaps ing disorder (McLellan, Lewis, OBrien, 2000), which is sometimes referred to as an addictio n career (Hser, Anglin, Grella, Longshore, Prendergast, 1997). Therefore, clients may go through multiple treatment episodes before they are able to successfully recover from addiction, and may require long-term treatment/intervention. Periodic relapses into substance use as well as multiple treatment episodes are viewed as predictable aspects of th e recovery process and constitute a treatment career (Hser, Anglin, Grella, Longshore, Pre ndergast, 1997). This study will explore the relationship between the amount of prior treatment or treat ment career and successful completion of the Family Treatment Drug Court program. Criminal Status Research indicates that an individual does not usually begi n substance abuse treatment until they are immersed in a lifestyle of dr ug use and criminal activity (Stephens, 1991). Growing prison populations in the U.S. are largel y due to drug-related crime and drug abuse. Yet, relatively few inmates receive treatment and existing interventions tend to be short-term or non-clinical (Belenko & Peugh, 2005). In 1997 a su rvey was conducted on inmates in state correctional facilities, a nationally representa tive sample of 14,285 inmates from 275 state prisons, in an effort to estimate their level of treatment need. The framework drawn on to estimate this level of need was derived from the American Society of Addiction Medicine Patient Placement Criteria and other assessment tools measuring drug use severity, drug-related behavioral consequences, and other social and health probl ems (Belenko & Peugh, 2005). The results of the survey indicated that one-third of the male and one-half of the female inmate 46

PAGE 47

population needed residential substa nce abuse treatm ent, while half of the male and one-third of the female inmate population may have needed either no treatment or short-term treatment interventions (Belenko & Peugh, 2005). Drug courts were established as an answer to the problem of the increase in the number of inmates charged with drug-related crimes. Re search conducted on drug court programs show favorable outcomes for particip ants with criminal backgrounds Some researchers have found that drug use and criminal activity are reduced for drug court participants while they are receiving treatment services (Belenko, 1999, 2001) and that retention rates for drug courts are higher than other treatment progr ams with criminal offenders (U .S. General Accounting Office, 1997). However, many evaluation studies of drug court effectiveness compare offenders who complete drug court with offenders who do not and find that successes succeed and failures fail (Goldkamp, White, & Robinson, p. 32, 2001). This study seeks to compare program participants with criminal histories with those who do not have criminal histories to determine the relationship with successful completion of the Family Treatment Drug Court program. Social Support Do participants with high levels of soci al support at treatment onset differ in their treatment outcomes from those with low levels of social support? Dobkin, De Civita, Paraherakis, & Gill (2001) examined the impact of functional support on treatment outcomes for substance abuse program particip ants. Social support was measured at intake and treatment outcomes were assessed 6 months later. Using regression analyses, a nd controlling for the effects of days in treatment pr ior to testing the independent a nd interactive effects of social support and stress on outcomes, higher levels of perceived functional suppor t were shown to play a role in reducing the severity of alcohol use indicating that there is an association between social support and the tendency for patients to stay in treatment resulting in higher rates of treatment 47

PAGE 48

com pletion (Dobkin, De Civita, Paraherakis, & Gill, 2001). This data confirms previous research findings (Huselid Self, &Gutierres, 1991; Westreich Heitner, Cooper, Galanter, & Gued, 1997) which suggests that little or no social support at intake may be predictive of poor treatment retention and poorer treatment outcomes. Research reveals that family relationships and other social institutions play an important role in treatment initia tion for men (Grella & Joshi, 1999); such institutions may include an employer or the criminal justice system. However, family relationships do not play as pivotal a role for women with more women being referred to treatment programs by social workers or caseworkers (Grella & Joshi, 1999). Research ha s shown that the involvement of significant others in a patients treatment program improves adherence to th e treatment program (Galanter, 1993). Therefore, more research is needed to dete rmine whether clients with little or no social support at the onset of treatment fare worse in Family Treatment Drug Court participation than those with higher levels of social support. CPS Involvement There is more awareness of the connec tion between substance abuse and child abuse/neglect prompting more coordination of services ( U.S. Department of Health and Human Services, 1999 ; Young, Gardner, & Dennis, 1998 ). Child Protection Services (CPS) work to link substance abusing parents to tr eatm ent services quickly to assist in improving treatment outcomes of participants and ev entual reunification with children. Yet, there are conflicting perspectives regarding the impact Child Protective Service involvement has on treatment completion of participants. Some researchers suggest that women i nvolved with CPS, including those who are pregnant, are more likely to have unsatisfactory discharges from treatment than those who are not involved with CPS ( Hohman, Shillington, & Baxter, 2003 ; Shillington et al., 2002 ). Research 48

PAGE 49

conducted by Kelly, Blacksin, & Mason (2001), found that a greater presence of Child Protection Services involvem ent reduced the likelihood of completion of substance abuse treatment. The study consisted of pregnant English-speaking wo men presenting for prenatal treatment at Cook County Hospital between 1992 and 1995, who admitted to abuse of heroin, cocaine, and alcohol. Women who agreed to participate in the study were randomly placed into two types of prenatal care programs: 1) treatment in the prenatal clinic at Cook County Hospital and referral for substance abuse treatment at a community agency, or 2) prenatal care, substance abuse treatment, and case management in the New Start progra m (Kelly, Blacksin, & Mason, 2001). There were 165 women randomly placed in the New Start program who were divided into two research samples, (1) completers (15 women) who met the criteria for completion of the treatment program(i.e., no relapse for one year, regular at tendance at program activities for at least one year, and initiation of a personal developmen t plan), and (2)non-completer s (19) women randomly selected from the women who participated in the program for at least three months, but who did not complete the steps required for completion by the programs criteria (Kelly, Blac ksin, & Mason, 2001). Data was obtained from the treatment records collected over the course of the participants treatment. Completers had significantly less involvement w ith the states child protectiv e services (CPS) than did noncompleters (27%, n = 4 vs. 74%, n =14). (Involvement w ith CPS means that women either had their children removed from their care or were mandated to treatment as a result of an investigation). Gregoire & Sc hultz (2001) also found a low rate of treatment completion (less than one-quarter) among parents referred to substa nce abuse treatment from child welfare, and that treatment non-completion was strongly asso ciated with continued substance abuse and eventual loss of parental rights. 49

PAGE 50

These studies reported th at the likelihood of women completing substance abuse treatment was reduced once their children have been taken away (Kelly, Blacksin, & Mason, 2001) which is in direct opposition to other research findings that re port that CPS involvement is often a motivator for treatment completion (W ald, 1991). Although some women will participate actively in treatment to regain custody of their children, others deteriorate when their children are removed from their custody and use drugs mo re heavily to cope w ith the loss (Kearney, Murphy, & Rosenbaum, 1994). Although all of the study participants have some involvement with CPS, the relationship between multiple CPS involvement episodes on participants treatment completion will be examined. Successful Completion Family treatment drug court programs vary in size and duration; however all have distinct markers of stage completion built into the program. Research has shown that longer participation in treatment increases the chan ce of favorable treatment outcomes (Peters & Murrin, 1998), therefore, particip ants who complete more stages in FTDCs may be more likely successfully complete the program. The drug court program under study has four stages of treatment completion divided into phases, which all program participants must reach before successfully completing and graduating from the program. The program is designed to reflect therapeutic engagement and the internal motivat ion of program particip ants. Treatment intensity is highest at the onset of the program as many clients present in the pre-contemplation and contemplation of the Transtheoretical m odel (1992) and are believed to require more assistance. In Phase I participants are required to attend treatment sessions (each session is three hours in length) four days a week, two AA/NA meetings a week, and court once a week. Participants are moved through the program stages as they meet treatment objectives and begin to display more treatment readiness/motiv ation indicated in the preparation and action 50

PAGE 51

stages of change of the Transt heoretical m odel (1992). Phas e II requires treatment attendance three days a week, three AA/NA meetings a week and bi-monthly court attendance. Phase III requires treatment attendance two days a wee k, four AA/NA meetings a week, and bi-monthly court appearances. Phase IV requires treatmen t attendance once a week, five AA/NA meetings a week, and bi-monthly court attendan ce. All participants are require d to obtain a 12-step sponsor by the end of the first phase of the program and meet regularly with him/her each week. Once the participant has completed Phase IV of the program that are classified as a successful completer. This study will explore the rela tionship between the variables under study and successful completion of the Fam ily Treatment Drug Court program. Summary The literature reviewed in this chapter i ndicates that Adult Drug Courts, which were developed in response to jail overcrowding, were effective in increasing substance abuse treatment retention of drug offenders and reducin g both criminal and substance abuse recidivism rates. Family treatment drug courts were adopted from the adult drug court model to address the increase in child abuse and neglect cases resultin g from substance abuse by parents. The goal is to help parents abstain from drugs/alc ohol and reunite with their children. FTDCs have been shown to work and are most effective when they are family centered and incorporate a variety of services (i.e., housin g, transportation, parenting classes, and social services). However, there are problems with the existing structure of the program which may impact participant completion rates. For exampl e, Child Protection Service workers often have large caseloads which make it difficult to see that parents are receiving needed services, there are deadlines imposed by the courts which place restri ctions on the amount of time participants have to complete treatment objectives, and there may be certain participant characteristics that impact successful completion rates. 51

PAGE 52

52 This study will look at six variables and their re lation to successful completion of a family treatment drug court program. These variables include: (1) participant s drug of choice, (2) participants frequency of drug us e (3) participants prior treatment history, (4) participants criminal status, (5) participants social suppor t, and (6) participants prior Child Protective Service involvement. Determining which particip ant characteristics affect successful completion would assist in improving program design.

PAGE 53

CHAP TER 3 METHODOLOGY This study is an archival anal ysis of the records of partic ipants of the Alachua County Family Treatment Drug Court or Dependency Dr ug Court Program in Gainesville, Florida. This study examined six factors associated with successful and unsuccessful completion by participants in the Family Treatment Drug Cour t program under study: (1 ) participants drug of choice, (2) participants frequency of drug use (3) participants prior treatment history, (4) participants criminal status, (5) participants social support, and (6) participants prior Child Protective Service involvement. Population and Sample The Dependency Drug Court (DDC) program in Alachua County began on January 19, 2001. Designed as an intensive outpatient substance abuse treatment program, utilizing detox and in-patient treatment services as needed, it incorporates comprehensive family services and court supervision and is approximately 1012 months in duration. Alachua Countys Dependency Drug Court program is funded by stat e dollars with a static population of 18 participants. The state appr opriates $112,000 per year as a recu rring annualized budget to fund the DDC program in Alachua County. Program size has been adjusted as the need for services has grown. In such cases, alternative sources of funding are sought for additional program participants. Participants are also responsible for comp leting all phases of the DDC program and all case plan goals given to them by the Child Pr otective Service agency in conjunction with participants substance abuse treatment; these may include classes in parenting, anger management, and/or domestic violence prevention. Parenting and anger management classes are 53

PAGE 54

provided at Meridian Beha viora l Healthcare, the treatment agen cy. Parents are also referred to other agencies within the community to fulfill other case plan tasks. Participants are randomly drug tested throughou t their participation in the program and must achieve definitive periods of abstinence (3 months abstinence) before unsupervised visitation and reunification with their children is granted. Each client is drug tested using a randomized telephone system. Participants are required to call each day Monday-Sunday by 9:00 a.m. They are greeted with a message anno uncing the DDC Color(s) of the Day and must present for drug testing by 9:00 p.m. The particip ant must present for urine screen testing when their color is named on the day of the message. If they do not come in for testing, this is judged as a positive screen and as being non-c ompliant with the treatment program. Prior to each Dependency Drug Court heari ng, the DDC team meets with the Judge or presiding Magistrate to review the progress of ea ch program participant. The Judge will discuss the participants progress during court and may either reward participants who are compliant with treatment or impose sanctions for thos e who are non-compliant. Rewards may include praise, advancement in program phase, a decrease in court appearance, recognition certificates, gifts, increased visitation with children, and re unification with children. DDC participants may be reunified with their children within 90 days of program admission if they meet the following criteria: (1) The overall risk has been reduced as a result of the clients demonstration of compliance with the DDC program, (2) The particip ant has complied with all aspects of the drug court program for a period of 90 days, including attendance and pa rticipation in all scheduled treatment sessions, (3) The participant has main tained abstinence for a minimum period of 90 days if treated through an outpatient program or a period of 30 days following discharge if treated in an in-patient program, (4) The partic ipant has maintained safe/stable housing for a 54

PAGE 55

period of 90 days, and (5) The participant has m ain tained a sufficient income to provide for the needs of their child(ren) for a period of 90 days DDC sanctions may include verbal reprimand from the bench, increased intensity of treatme nt, community service hours, suspension of visitation with child(ren) or reduction from superv ised visits to unsupervis ed visits, unsuccessful discharge/termination from the DDC program, a nd/or recommendation to file a petition for termination of parental rights. Participants graduate or successfully complete the Dependency Drug Court program when they have completed all treatment phases of the program, have maintained abstinence from drugs/alcohol for a period of no less than 180 da ys, completed any and all DDC sanctions, and developed a plan for ongoing recovery and relapse prevention. Determination if the participant has reached final attainment of these objectiv es is decided upon by the DDC team, who will conclude if the participant successfully or unsuccessfully completes the program. The sample for this study was obtained from th e clinical records of participants of the Dependency Drug Court program in the 8th Judicial Circuit in Alac hua County, FL. The records of participants include the Child Protection Servi ces case plan and shelter petition that discusses the circumstances which resulted in the participan ts referral to treatment, as well as, case plan goals to be completed for reunification. The case plan/shelter petition also provides information on any history of participant involvement with CPS. In addition, the clinical records provide information on the participants demographic information (age gender, ethnicity, education level, and employment status), medical/health history, family history, mental health history, criminal history, and substance abuse history. Clinical records also include documentation on participants progress in treatment towards co mpleting goals and objec tives and all records 55

PAGE 56

include an account of th e participants status at discharge (successful completion versus unsuccessful completion). The sample will consist of n = 225 participants who were admitted and discharged from the DDC program between January 19, 2001 and Janua ry 1, 2008. Although it is estimated that nearly 400 individuals were re ferred and evaluated for the DDC program during this time, inclusion in the study requires that the participant met diagnostic cr iteria for participation in the program and agreed to participat e at the time of evaluation. Pa rticipants must be discharged (successfully or unsuccessfully) from the DDC pr ogram to be included; therefore, all clients currently participating in the program will be excluded. The sample consists of 27 (12%) male participants and 198 (88%) females. The average age of particip ants is between 30-35, single, and unemployed at the time of entry. About one half are white and one half are AfricanAmerican. Measurement The predictor variables in th e study are: participants drug of choice, frequency of use, prior treatment history, criminal status, social support, and prior CPS involvement. The criterion variable is successful completion of Dependency Dr ug Court. Three clinicians from the selected agency were chosen to review the coding scheme for assessing the level of social support and stages of change demonstrated by the participants. All three clinicians worked in substance abuse treatment programs for five or more years. The first clinician was a residential substance abuse treatment provider and the second and third worked as outpatient substance abuse treatment providers. The following sections describe how each variable was assessed. Criminal Status. This measure refers to the participan ts criminal status at the time they were admitted to the Dependency Drug Court program A four point rating scale was used to measure criminal status: no history of crimin al involvement = 0, participant not under legal 56

PAGE 57

supervision at the tim e of admissi on but at least one previous cr iminal charge = 1, participant under legal supervision at the time of admission = 2, participant under lega l supervision at the time of admission and concurrently admitted to Adult Drug Court program = 3. This study assessed the relationship between criminal status of the participant and successful completion of Dependency Drug Court. Drug of Choice. This measure refers to the parents drug of choice at the time they were admitted to the Dependency Drug Court program one month prior to admission. A five point rating scale was used indicati ng dependence on 1 = cocaine, 2 = alcohol, 3 = marijuana, 4 = opiates, and 5 = heroin. Depende nce is defined as having met DSM-IV criteria for lifetime dependence. Dependence is defined as a malada ptive pattern of subs tance use leading to clinically significant impairment or distress as manifested by one (or more) of the following, occurring within a 12-month period: (1) Recurren t substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performan ce related to substance use; substance-related absences, suspensions, or expulsions from school ; or neglect of children or household), (2) Recurrent substance use in situations in whic h it is physically hazardous (such as driving an automobile or operating a machine when impair ed by substance use), (3) Recurrent substancerelated legal problems (such as arrests for s ubstance related disorder ly conduct), and (4) Continued substance use despite having persistent or recurrent so cial or interpersonal problems caused or exacerbated by the effect s of the substance (for exampl e, arguments with spouse about consequences of intoxication and physical fights) This study set out to clarify the relationship between drug of choice and successful completion of Dependency Drug Court. 57

PAGE 58

Frequency of Drug Use. A five point rating scale was us ed to assess the frequency of use with 1 = No past m onth use, 2 = 1 to 3 times in past month, 3 = 1 to 2 times per week, 4 = 3 to 6 times per week, and 5 = Daily use. This study set out to clarify the relationship between frequency of use and successful co mpletion of Dependency Drug Court. Prior CPS involvement. This four point scale measured prior Child Protective Service involvement of the participant at the time of admission into the Dependency Drug Court program. All parents who had have had one prio r open case with the Depa rtment of Children & Families (whether the case was closed or not) wa s coded as 1, 2 prior cases was coded as 2, 3 prior cases was coded as 3, and termination of pare ntal rights was coded as 4. This study set out to clarify the relationship between prior CPS involvement and completion of Dependency Drug Court. Prior treatment history. This measure refers to the treatment history of the participant at the time of admission into the Dependency Drug Court program. Participants number of prior treatment involvements and level of treatment car e was rated on a six point scale regarding the treatment they have participated in. Partic ipants who received treatment once for a drug or alcohol problem (whether they successfully completed treatment or not) in a traditional outpatient program (once a week for 3 months of treatment minimum) will be coded as 1, intensive outpatient treatment (3-5 days a week for 3 months of treatment minimum) will be coded as 2, residential treatment (28 days minimum) will be coded as 3. More than one outpatient treatment admission (outpa tient or intensive outpatient) will be coded as 4 and more than one residential admission will be coded as 5. No prior treatment history will be coded as 0. This study set out to clarify the relationship between prior treatment history and completion of Dependency Drug Court. 58

PAGE 59

Social support. This variable refers to the source s of social support that the parent received from friends, fam ily, spouses/partner, an d other members of the family as reported in their bio-psychosocial evaluati on. Social support was also in dicated by recovery peer group support, such as Alcoholic Anonymous groups an d Narcotics Anonymous groups. In addition, support from other institutions was considered as a level of support (such as employer, case manager, counselor, etc). Social support was assessed in terms of five categories developed by the researcher and reviewed by the panel of three clinicians. Th e categories were coded from 1 to 5. Having no social support system was code d as 1, in serious conflict with and/or having been pressured to receive treatment by ones support system was coded as 2, support from friends/family, spouse/partner was coded as 3, support from support groups was coded as 4, support from other institutions was coded as 5. This study set out to clarify the relationship between social support of the participan t and completion of Dependency Drug Court. Successful Completion. This variable is operationally defined as the completion of a program participant due to attain ment of objectives and compliance with program rules. For the purposes of this study, participants completion st atus (i.e. successful completion or unsuccessful completion) was assigned according to the status at the end of their participation in the Dependency Drug Court program. There are four phases in the DDC program participants must complete. Phase I is the most intensive phase of the program which requires attendance of treatment sessions four days a week (three hour s in length) two AA/NA meetings a week, and weekly court appearances. Participants must also obtain a 12-step sponsor during Phase I prior to moving to Phase II. Phase II requires trea tment attendance three days a week, three AA/NA meetings a week, work with a 12-step sponsor, and bi-monthly court attendance. Phase III requires treatment attendance two days a week, four AA/NA meetings a week, work with a 1259

PAGE 60

step sponsor, and bi-m onthly court appearances. Phase IV requires treatment attendance once a week, five AA/NA meetings a week, work w ith a 12-step sponsor, and bi-monthly court attendance. Date on stage of treatment completion was collected to examine in which phase program participants were discharged if they uns uccessfully completed the program. This data was coded using a five point scale ranging from 1 and 4. Phase I was coded as 1, phase II was coded as 2, phase III was coded as 3, phase IV was coded as 4. Participants who successfully completed the program were coded as 5. Null Hypotheses The following (seven) hypotheses will be tested in this study: Ho1: There is no contribution to the prediction of successful completion of Dependency Drug Court of participants drug of choice, frequency of drug use, treatment history, criminal status, sources of social support, and involv ement with Child Protective Services. Ho2: There is no relationship between succe ssful completion of Dependency Drug Court and participants drug of choice. Ho3: There is no relationship between succe ssful completion of Dependency Drug Court and participants frequency of drug use. Ho4: There is no relationship between succe ssful completion of Dependency Drug Court and participants treatment history prior to program admission. Ho5: There is no relationship between succe ssful completion of Dependency Drug Court and criminal status of the participant at time of program admission. Ho6: There is no relationship between succe ssful completion of Dependency Drug Court and sources of social support among particip ants at time of program admission. Ho7: There is no relationship between succe ssful completion of Dependency Drug Court and participants prior involvement with Child Protective Services. Data Collection Meridian Behavioral Healthca re, Inc provided permission for the investigator to collect data from the clinical records of past participants of the Alachua C ounty Dependency Drug Court 60

PAGE 61

program A list of participants admitted to the DDC program from January 19, 2001 to January 1, 2008 was obtained from the agencys medical ma nager computer program. This list was then compared to a list of participants curre ntly active in the DDC pr ogram and duplicate names were removed from the list of st udy participants. However any participants that were currently admitted to the DDC program, with prior partic ipation, who were discharged from the program were included. The list of study participants was then sent to the agencys medical records department who pulled the clinical records of the participants for examination. Two investigators, the primary investigator and a treatment clinician, were used to review and code data from the clinical records in the medical record department. The treatment clinician was a substance abuse treatment provider for th e agency under study. She had over five years experience working with an intensive outpatient substance abuse program and familiarity with Family Treatment Drug Court programs, having worked with this population for approximately two years. The clinician was provided with the policies and procedures manual for the Dependency Drug Court program a nd training which consisted of a review of Dependency Drug Court program rules/objectives, admission criteria discharge criteria, and program design. The clinician was then provided with a guide for c oding criteria agreed upon by the expert panel for each variable in the study. The investigators th en followed the coding criteria set by the panel to record the data. If there was a disagreement among the investigators regarding the coding of a variable, that participant was excluded from the data. An application to the Institutional Review Board (IRB) was submitted requesting an exempt status since the study involved the collection of existing data. Data was also recorded so that no program participants could be identified. 61

PAGE 62

62 Data Analytic Procedures The hypotheses for this study were tested using Hierarchal Logistic Regression procedures performed by the st atistical program Statistical Package for the Social Sciences (SPSS). The following sets of predictors were us ed in the hierarchal l ogistic regression model: person-centered factors (drug of choice, frequency of drug use, tr eatment history, criminal status, social support, and prior C PS involvement). Alpha ( ) was set at 0.05. Demographic information (age, gender, ethnicity, and educat ional level) while in the DDC program was collected to examine any correla tions with successful completion.

PAGE 63

CHAP TER 4 RESULTS The purpose of this study was to examine the relationships between participants successful or unsuccessful completion of a Fa mily Treatment Drug Court program and their reported drug of choice, frequency of use, criminal status at the time of admission, type of social support, and their prior involvement with Child Protective Services (CPS). In addition, demographic information (age, gender, race, and education) was also collected to determine if there were demographic differences between suc cessful and unsuccessful participants. Data were analyzed using hierarchical logistic re gression to examine the relationship of these variables to successful or unsucces sful completion. In this chap ter, a description of the study sample is presented, followed by the results for each research question, and a summary of the findings. Description of the Sample The participants for this study were drawn from Dependency Drug Court (DDC) participants of the 8th Judicial Circuit Court in Gainesvill e, Florida discharged between January 1, 2001 and January 1, 2008. After gain ing Institutional Review Boar d (IRB) approval, a list of participants admitted to the DDC program dur ing the time frame was generated using the medical manager computer system of the particip ating agency. The 225 names on the list were reviewed to determine if any of the participants were currently active in the DDC program. Ten participants who were active clie nts were deleted from the list. The remaining list of 215 DDC participants was then examined for duplicate names. Seventeen duplicates were deleted resulting in a sample of 198 participants. This list of 198 study part icipants was then sent to the agencys medical records department and their clinical records were requested. In the course of reviewing the files, it was discovered that 12 pa rticipants had been admitted to the DDC program 63

PAGE 64

in erro r as they had either been referred and/or participated in other treatment programs within the agency. Eliminating these 12 participants resulted in a total sample of 186 participants for the study. Age Descriptive information was collected from each of the participants c linical record and the data are presented in Table 4-1. In Table 4-1 you will see information on gender, age, and ethnicity for the total sample and for the two subgroups of successful and unsuccessful completers. There were 163 females (88.1%) and 22 males (11.9%) in the study sample. Participants ranged in age between 18-25 (N =49, 26.5%), 26-30 years of age (N=46, 24.9%), 3136 years of age (N=44, 23.8%), and 37+ years of age (N=46, 24.9%). For the most part, the racial/ethnic composition of the study sample was either African-American (N=88, 47.6%) or Caucasian (N=92, 49.7%). Only two Hispanics (1.1%), two mixed ethnic (1.1%), and one American Indian (.5%) were in th e sample, and none of the particip ants identified themselves as Asian-American. While clients were evenly distributed acro ss categories of age, there were marked differences in age between members of the succe ssful and unsuccessful group. As depicted in Table 4-1, for successful completers, more pa rticipants (N=13, 28.3%) were 37+, followed by participants between 31-36 (N =11, 25.0%) years of age, participants between 26-30 (N=5, 10.9%) years of age, and participants betw een 18-25 (N=5, 10.2%). For unsuccessful completers, more participants (N=44) were betw een 18-25 years of age, followed by participants between 26-30 (N=41) years of age, participants 31-36 (N=33) years of age, and participants 37+ (N=33). 64

PAGE 65

Table 4-1. G ender, Age, & Ethnicity Gender Successful Total No Yes N (%) N (%) N (%) Female 130 (81.6) 33 (18.4) 163 (88.1) Male 21 (95.5) 1 (4.5) 22 (11.9) Age Successful Total No Yes N (%) N (%) N (%) 18-25 44 (89.8) 5 (10.2) 50 (26.5) 26-30 41 (89.1) 5 (10.9) 46 (24.9) 31-36 33 (75.0) 11 (25.0) 44 (23.8) 37+ 33 (71.7) 13 (28.3) 46 (24.9) Ethnicity Successful Total No Yes N (%) N (%) N (%) Caucasian 72 (78.3) 20 (21.7) 92 (49.7) Persons of Color 79 (84.9) 14 (15.1) 93 (50.3) African-American, mixed ethnic, and American I ndian categories were combined into persons of color. Education Level As depicted in Table 4-2, ni nety-six (51.4%) of th e total sample reported having less than a high school diploma, fifty-four (29.2%) reported having a hi gh school diploma, 26 (14.1%) reported having some college, seven (3.8%) report ed having an Associates Degree, and three (1.6%) reported having a Bachelors Degree. There were no particip ants who had earned graduate degrees (Masters or Doctorate). Th e highest number of successful completers were participants with some college or a college degree (N=8, 23.5%) followed by participants with 65

PAGE 66

high school diplom as (N=10, 29.4%) and participan ts with less than a high school diploma (N=16, 47.1%). Table 4-2. Education. Education Successful Total No Yes N (%) N (%) N (%) Less than high school diploma 79 (83.2) 16 (16.8) 96 (51.4) High school diploma 44 (81.5) 10 (18.5) 54 (29.2) Some college and college degree 28 (77.8) 8 (22.2) 36 (19.5) *Some college, Associate degree, and Bachelors degree were comb ined into some college and college degree. Stage of Treatment Stage of treatment was the dependent variable in this study. There are four phases in the DDC program participants must complete. Phase I of the program requires participants to attend treatment sessions four days a week (each sessio n is three hours in length), two AA/NA meetings a week, and weekly court appearances. Participan ts are also required to obtain a 12-step sponsor during Phase I and maintain weekly contact with them prior to moving to Phase II. Phase II requires treatment attendance three days a wee k, three AA/NA meetings a week, work with a 12step sponsor, and bi-monthly court attendance. Ph ase III requires treatm ent attendance two days a week, four AA/NA meetings a week, work w ith a 12-step sponsor, and bi-monthly court appearances. Phase IV requires treatment a ttendance once a week, five AA/NA meetings a week, work with 12-step sponsor, and bi-monthly court attendance. Participants who were discharged in Phase I, Phase II, Phase III, and Phase IV were considered unsuccessful completers. Participants may be discharged from the Dependency Drug Court program if they fail to meet the treatment objectives of the program, fail to comply with 66

PAGE 67

any sanctions im posed by the DDC team, and if they drop out from the DDC program. Participants who successfully completed Phase IV of the Dependency Drug Court program were judged to be successful completers. The majority of participants, 121 (65.4%), were discharged in Phase I of the program within the first 60 da ys of treatment. There were 16 (8.6%) who were discharged in Phase II, 7 (3.8%) who were discharged in Phase III, and 7 (3.8%) who were discharged in Phase IV. Only 34 (18.4%) participants successfully completed all phases of the Dependency Drug Court program. Criminal Status Participants criminal status was classified in to 1 of 4 categories: no history of criminal involvement, not under legal supe rvision at admission, under superv ision at admission, and legal supervision at admission and conc urrently participating in an A dult Drug Court program. Within the total sample, 45 (24.3%) had no past and/or cu rrent criminal justice involvement, 86 (46.5%) were not under legal supervis ion at admission, 49 (26.5%) were under legal supervision at admission, and 5 (2.7%) were under legal supervision and concurrently participating in an Adult Drug Court program. A Chi Square test was not able to be conducte d to test the signifi cance of the following differences as there were cells less than five However, among the successful completers, 9 (20.0%) had no history of criminal involvement, 14 (16.3%) were not under legal supervision at the time of admission but had at least one previo us criminal charge, 9 (18.4%) were under legal supervision at the time of admi ssion, and 2 (5.9%) were under legal supervision at the time of admission and concurrently admitted to th e ADC program. Among the unsuccessful completers, 36 (23.8%) had no history of criminal involvement, 72 (47.7%) were not under legal supervision at the time of admi ssion but had at least one previ ous criminal change, 40 (26.5%) 67

PAGE 68

were under legal supervision at the tim e of admission, and 3 (2.0 %) were under legal supervision at the time of admission and concurrently admitted to the ADC program. Table 4-3. Criminal Status Criminal Status Unsuccessful Successful Total N (%) N (%) N (%) No history of criminal involvement 36 (23.8) 9 (26.5) 45 (24.3) Not under legal supervision at admission 72 (47.7) 14 (41.2) 86 (46.5) Under legal supervision at admission 40 (26.5) 9 (26.5) 49 (26.5) Legal supervision at admission and currently 3 (2.0) 2 (5.9) 5 (2.7) Drug of Choice Participants drug of choice was classified into 1 of 5 categorie s: cocaine, alcohol, marijuana, opiates, and heroin. Part icipants could indicate more th an one drug of choice and they would be coded as yes within each of the five categories. Within the total sample, 131 (70.8%) reported cocaine as their drug of choice, 90 (48.6 %) reported alcohol as their drug of choice, 90 (48.6%) reported marijuana as th eir drug of choice, 12 (6.5%) repor ted opiates as their drug of choice, and 1 (0.5%) reported hero in as their drug of choice. A Chi Square test was not able to be conducte d to test the significance of the following differences as there were cells less than five However, among the successful completers, 23 (67.6%) reported cocaine as their drug of choi ce, 18 (52.9%) reported alcohol as their drug of choice, 12 (35.3%) reported marijuana as their drug of choice, 1 (2.9%) re ported opiates as their drug of choice, and 0 (0.0%) reported heroin as their drug of choice. Among the unsuccessful 68

PAGE 69

com pleters, 108 (71.5%) reported cocaine as their dr ug of choice, 72 (47.7%) reported alcohol as their drug of choice, 78 (51.7%) re ported marijuana as their dr ug of choice, 11 (7.3%) reported opiates as their drug of choice, and 1 (0.7 %) reported heroin as their drug of choice. Table 4-4. Drug of Choice Drug of Choice Unsuccessful Successful Total N (%) N (%) N (%) Cocaine 108 (71.5) 23 (67.6) 131 (70.8) Alcohol 72 (47.7) 18 (52.9) 90 (48.6) Marijuana 78 (51.7) 12 (35.3) 90 (48.6) Opiates 11 (7.3) 1 (2.9) 12 (6.5) Heroin 1 (0.7) 0 (0.0) 1 (0.5) Drug of Choice: Single Drug use versus Multiple Drug Use Participants were separated into two groups DC1= those who reported a single substance as their drug of choice and DC2= those who reported multiple substances as their drug of choice. Within the total sample, 70 (37.8%) reported a sing le substance as their drug of choice and 115 (62.2%) reported multiple substances as their drug of choice. Among the successful completers, 16 (47.1%) repo rted a single substance as their drug of choice and 18 (52.9%) reported multiple substa nces as their drug of choice. Among the unsuccessful completers, 54 (35.8%) reported a singl e substance as their drug of choice and 97 (64.2%) reported multiple substances as their drug of choice. There were no statistically significant Chi S quare differences between successful and unsuccessful completers for participants who repo rted a single substance as their drug of choice 69

PAGE 70

versus participants who reported m ultiple substances as thei r drug of choice, (X2 (1) 1.506, p = 0.220). Table 4-5. Drug of Choice (Single Drug Use versus Multiple Drug Use) Unsuccessful Successful Total DC Group N (%) N (%) N (%) 1 54 (35.8) 16 (47.1) 70 (37.8) 2 97 (64.2) 18 (52.9) 115 (62.2) *DC 1 = single drug use *DC 2 = multiple drug use Frequency of Use Participants frequency of use wa s classified into 1 of 5 categor ies: no past month use, 1 to 3 times in past month, 1 to 2 times per week, 3 to 6 times per week, and daily use. Within the total sample, 42 (22.7%) reported no past month use, 28 (15.1%) reported us e 1 to 3 times in the past month, 28 (15.1%) reported use 1 to 2 times per week, 15 (8.1%) reported use 3 to 6 times per week, and 69 (37.3%) reported daily use. A Chi Square test was not able to be conducte d to test the signifi cance of the following differences as there were cells less than five However, among the successful completers, 12 (35.3%) reported no past month use, 5 (14.7%) re ported use 1 to 3 times in the past month, 7 (20.6%) reported use 1 to 2 times per week, 1 (2 .9%) reported use 3 to 6 times per week, and 9 (26.5%) reported daily use. Among the unsucces sful completers, 30 (19.9%) reported no past month use, 23 (15.2%) reported use 1 to 3 times in the past month, 21 (13.9 %) reported use 1 to 2 times per week, 14 (9.3%) reported use 3 to 6 times per week, and 60 (39.7%) reported daily use. There were marked differences between successful and unsuccessful completers who reported higher frequencies of use and participants who reported lower frequencies of use. Only 70

PAGE 71

29.4% of participan ts successfully completed who reported use 3 to 6 times per week and daily use, compared with 70.6% of successful complete rs among participants who reported use 1 to 2 times per week or less. Table 4-6. Frequency of Use Frequency of use Unsuccessful Successful Total N (%) N (%) N (%) No past month use 30 (19.9) 12 (35.3) 42 (22.7) 1 to 3 times in past month 23 (15.2) 5 (14.7) 28 (15.1) 1 to 2 times per week 21 (13.9) 7 (20.6) 28 (15.1) 3 to 6 times per week 14 (9.3) 1 (2.9) 15 (8.1) Daily use 60 (39.7) 9 (26.5) 69 (37.3) CPS Involvement Participants CPS involvement was classified into 1 of 4 categories: one prior open case, two prior open cases, thr ee prior open cases, and termination of parental rights. One prior open case denotes at least one prior ope n investigation by child protectiv e services before admission to the Dependency Drug Court program. Within the total sample, 132 (71.4%) reported one prior open case, 17 (9.2%) reported two prior open cases, 28 (15.1%) reported three prior open cases, and 8 (4.3%) reported past termination of parental rights. Among the successful completers, 26 (76.5%) reported one prior open case, 5 (14.7%) reported two prior open cases, 1 (2.9%) reported three prior open cases, and 2 (5.9%) reported past termination of parental rights. Among the unsuccessful completers, 106 (70.2%) reported 71

PAGE 72

one prior open case, 12 (7.9%) reported two prior open cases, 27 (17.9%) reported three prior open cases, and 6 (4.0%) reported past term ination of parental rights. There were no statistically significant Chi Square between successful and unsuccessful completers in terms of their prior CPS involvement of the following three categories: one prior open case with the Department of Children & Families ( X2 (1) 0.534, p = 0.465), two prior open cases ( X2 (1) 1.519, p = 0.218), and termination of parental rights (X2 (1) 0.244, p = 0.621). Significant differences were found between succe ssful and unsuccessful participants in the frequency with which they repor ted three prior open cases ( X2 (1) 4.822, p = 0.028). However this may not be a valid analysis as there were cells with counts of five or less. Table 4-7. Prior CPS Involvement Prior CPS Involvement Unsuccessful Successful Total N (%) N (%) N (%) One prior open case 106 (70.2) 26 (76.5) 132 (71.4) Two prior open cases 12 (7.9) 5 (14.7) 17 (9.2) Three prior open cases 27 (17.9) 1 (2.9) 28 (15.1) Termination of parental rights 6 (4.0) 2 (5.9) 8 (4.3) Prior Treatment Participants prior treatment status was classifi ed into 1 of 6 categories: no prior treatment history, one treatment admission in traditional outpatient program, one treatment admission in intensive outpatient program, one treatment ad mission in residential pr ogram, more than one outpatient (traditional or intensive) admission, and more than one residential admission. Within the total sample, 95 (51.4%) repo rted no prior treatment histor y, 38 (20.5%) reported one prior 72

PAGE 73

trea tment admission in traditional outpatient, 14 (7.6%) reported one prior treatment admission in intensive outpatient, 31 (16.8%) reported one prior treatment admission in residential, 12 (6.5%) reported more than one outpatient admi ssion, and 15 (8.1%) more than one residential admission. A Chi Square test was not able to be conducte d to test the significance of the following differences as there were cells less than five However, among the successful completers, 14 (41.2%) reported no prior treatment history, 9 (2 6.5%) reported one prior treatment admission in traditional outpatient, 4 (11.8%) reported one prio r treatment admission in intensive outpatient, 9 (26.5%) reported one prior treatment admission in residential, 3 (8.8%) reported more than one outpatient admission, and 3 (8.8%) more th an one residential admission. Among the unsuccessful completers, 81 (53.6%) reported no prior treatment history, 29 (19.2%) reported one prior treatment admission in traditional outpa tient, 10 (6.6%) reported one prior treatment admission in intensive outpat ient, 22 (14.6%) reported one prior treatment admission in residential, 9 (6.0%) reported more than one outpatient admission, and 12 (7.9%) more than one residential admission. 73

PAGE 74

Table 4-8. P rior Treatment History Prior Treatment History Unsuccessful Successful Total N (%) N (%) N (%) No prior treatment history 81 (53.6) 14 (41.2) 95 (51.4) One treatment admission in traditional outpatient 29 (19.2) 9 (26.5) 38 (20.5) One treatment admission in intensive outpatient 10 (6.6) 4 (11.8) 14 (7.6) One treatment admission in residential 22 (14.6) 9 (26.5) 31 (16.8) More than one outpatient admission 9 (6.0) 3 (8.8) 12 (6.5) More than one residential admission 12 (7.9) 3 (8.8) 15 (8.1) Social Support Participants source of social support was classified into 1 of 5 categories: no social support system, in serious conflict with and/or having been pressured to receive treatment by ones support system, friends/family/spouse/ partner, support groups (AA/NA), and other institutions. Within the total sample, 60 ( 32.4%) reported no social support system, 34 (18.3%) reported that they were in serious conflict with and/or had been pressured to receive treatment by their support system, 64 (34.6%) re ported receiving support from friends/family/spouse/partner, 4 (2.2%) reported receiving support from support groups (AA/NA), and 19 (10.3%) reported receiving support from other institutions. 74

PAGE 75

Am ong the successful completers, 2 (5.9%) re ported no social support system, 0 (0.0%) reported that they were in serious conflict with and/or had been pressured to receive treatment by their support system, 31 (91.2%) re ported receiving support from friends/family/spouse/partner, 3 (8.8%) reported receiving support from s upport groups (AA/NA), and 9 (26.5%) reported receiving support from other in stitutions. Among the unsucce ssful completers, 58 (38.4%) reported no social support system, 56 (37.1%) repor ted that they were in serious conflict with and/or had been pressured to receive treatment by their s upport system, 33 (21.9%) reported receiving support from friends/f amily/spouse/partner, 1 (0.7%) re ported receiving support from support groups (AA/NA), and 10 (6.6%) reported receiving support from other institutions. Significant differences were found for source s of Social Support; however Chi Square findings may be invalid as there we re cells with counts of less than five. Chi Square results were as follows: having no social support system ( X2 (1) 13.399, p = <.001), in serious conflict with and/or having been pressured to receive treatment by ones support system ( X2 (1) 18.083, p = <.001), support from frie nds/family, spouse/partner ( X2 (1) 58.940, p = <.000), support from support groups (AA/NA) ( X2 (1) 8.738, p = 0.003), and support from other institutions (i.e. employer) ( X2 (1) 11.863, p = 0.001). 75

PAGE 76

Table 4-9. S ocial Support Social Support Unsuccessful Successful Total N (%) N (%) N (%) No social support system 58 (38.4) 2 (5.9) 60 (32.4) In serious conflict with and/or having been pressured to receive treatment by ones support system 56 (37.1) 0 (0.0) 34 (18.3) Friends/family/ spouse/ partner 33 (21.9) 31 (91.2) 64 (34.6) Support groups (AA/NA) 1 (0.7) 3 (8.8) 4 (2.2) Other institutions 10 (6.6) 9 (26.5) 19 (10.3) A post hoc analysis was conducted on year of admission of the participants following discovery that there was a dramatic change in admission criteria in 2004. From 2001-2003 participants who were found clin ically appropriate for the Dependency Drug Court program were required to request admission befo re they were accepted into th e program; however, beginning in 2004, all clients found clinically appropriate for the program were recommended for participation. A Chi Square test was not able to be conducted to test the significance of the following differences as there were cells less than five. However, there were more successful completers in 2002 (N= 5, 33.3%) followed by 2001 (N= 5, 29.4%) and 2003 (N= 5, 25.0%). Although there were more participants being admitted to the DDC program in 2004 the rate of successful completion declined with seven successful program co mpleters in 2006 (20.6%) six in 2005 and one (2.9%) successf ully completing in 2007. 76

PAGE 77

Table 4-10. Year of Adm ission Year of Admission Successful Total No Yes N (%) N (%) N (%) 2001 12 (70.6) 5 (29.4) 17 (9.1) 2002 10 (66.7) 5 (33.3) 15 (8.1) 2003 15 (75.0) 5 (25.0) 20 (10.8) 2004 20 (80.0) 5 (20.0) 25 (13..5) 2005 30 (83.3) 6 (16.7) 36 (19.5) 2006 36 (83.7) 7 (16.3) 43 (23.2) 2007 28 (96.6) 1 (3.4) 29 (15.6) In summary, when examining the relationshi p of all variables t ogether on successful completion of the Dependency Drug Court program, the chi-square test revealed there were significant differences for CPS involvement. Th e most significant difference being clients who reporting three prior open cases ( X2 (1) 4.116, p = 0.042). Among the successful completers, there were 28 (15%) of the participants who re ported having had three prior CPS cases. In addition, successful completers reported more so cial support from frie nds/family/spouse/partner ( X2 (1) 4.358, p = 0.037) and other institutions ( X2 (1) 3.834, p = 0.050). There were 64 (34.5%) who reported receiving social support from friends/family/spouse/partner and 19 (10.3%) who reported receiving social support from other institutions. Hypothesis Testing This study addressed the following hypotheses: Ho1: There is no contribution to the prediction of successful completion of Dependency Drug Court of participants drug of choice, frequency of drug use, treatment history, criminal status, sources of social support, and involv ement with Child Protective Services. Ho2: There is no relationship between succe ssful completion of Dependency Drug Court and participants drug of choice. 77

PAGE 78

Ho3: There is no relationship between succe ssful completion of Dependency Drug Court and participants frequency of drug use. Ho4: There is no relationship between succe ssful completion of Dependency Drug Court and participants treatment history prior to program admission. Ho5: There is no relationship between succe ssful completion of Dependency Drug Court and criminal status of the participant at time of program admission. Ho6: There is no relationship between succe ssful completion of Dependency Drug Court and sources of social support among particip ants at time of program admission. Ho7: There is no relationship between succe ssful completion of Dependency Drug Court and participants prior involvement with Child Protective Services. Data Analysis Hypothesis 1 : There is no contribution to the predicti on of successful completion of Dependency Drug Court of participants drug of choice, frequency of drug use, treatment history, criminal status, sources of social support, and involvement with Child Protective Services. Hierarchical logistic regre ssion was conducted to test H ypothesis 1 of the research questions. The independent variables were entere d hierarchically in the following order: drug of choice (DC), frequency of use (F U), prior treatment (PT), crimin al status (CS), social support (SS), and prior CPS involvement (CPS). The depe ndent variable was the dichotomous variable of successful or unsuccessful trea tment completion. Hierarchical logistic regression enters the variables in a specific order sp ecified by the researcher. The final model includes all of the variables but it is possible in a hierarchical regression to note changes in the model as the different variables or sets of variables are en tered into the model. Table 4-11 presents summed coefficients for each category and i llustrates the classifica tion of the participants for each step in the hierarchical regression. When comparing th e predicted values for the dependent variable based on the logistic regression model with the ac tual observed values from the data, the final model indicated 84.9% of the participants were correctly identifie d or predicted in their groups 78

PAGE 79

by the m odel. The Wald statistics indicated drug of choice, prior treatment, and social support were significant predictors of successful or unsuccessful completion of the program. There was a significant difference reported am ong marijuana as a drug of choice. There were more unsuccessful completers ( N =78, 51.7%) for those identifying marijuana as their drug of choice and fewer successful completers ( N =12, 35.3%) who identified marijuana as their drug of choice. For prior treatment, there was a si gnificant difference between participants with no prior treatment history and participants with at l east one prior treatment episode. The majority of participants ( N =81, 53.6%) who were unsuccessful completers had no prior history of treatment. Statistical differences were also found for social support, with the majority of successful as compared to unsuccessful completers re porting that they received support from friends/family/spouse/partner ( N =31, 91.2%). The final model indicated an overall model fit of three predictors was marginally satisfactory (-2 Log Likelihood 149.701) but was acceptable in distinguishing between successful versus unsuccessful participants (X2 (1) = 17.825, p=<.001) at the fifth step. In the analysis, criminal status and prior CPS involveme nt did not enter the m odel at their respective steps. Given these findings we can reject hypothes is 1 because drug of choice, prior treatment, and social support were found to be significant. 79

PAGE 80

Table 4-11. Regression Coe fficients for Hierarchi cal Logistic Regression Step Variable Wald df p Odds CI 1 DC -.470 2.445 1 .118 .625 .347-1.126 2 DC -.492 2.658 1 .103 .612 .339-1.104 FU 19.925 .000 1 .999 .000008 .000 3 DC -.507 2.659 1 .103 .601 .327-1.108 FU 20.598 .000 1 .999 .0000008 .000 PT 1.028 4.997 1 .025 2.795 1.135-6.881 4* DC -.507 2.659 1 .103 .602 3.27-1.108 FU 20.598 .000 1 .999 .0000008 .000-.000 PT 1.028 4.997 1 .025 2.795 1.135-6.881 CS* 5` DC -.726 4.553 1 .033 .484 .148-.943 FU 20.364 .000 1 .999 .0000008 .000-.000 PT 1.011 4.455 1 .035 2.747 1.075-7.022 CPS* SS 2.273 15.836 1 <.001 9.709 3.169-29.741 6 DC -.726 4.553 1 .033 .484 .248-.943 FU 20.364 .000 1 .999 .0000008 .000-.000 PT 1.011 4.455 1 .035 2.747 1.075-7.022 SS 2.273 15.836 1 <.001 9.709 3.169-29.741 Hypothesis 2 : There is no relationship between suc cessful completion of Dependency Drug Court and participants drug of choice. 80

PAGE 81

Logistic regression was conducted f or the gr ouped variable: drug of choice (DC), The dependent variable was the dichotomous variab le of successful or unsuccessful treatment completion derived from the stage of treatment with phases one to four being unsuccessful and successful completion. Drug of choice was found to be significant with marijuana (DC3) showing statistical significance. When compar ing the predicted values for the dependent variable based on the logistic regression model with the actual observed values of data in participants drug of choice, the final model indicated 81.6% of th e participants were correctly identified or predicted in their groups by the model. Table 4-12 presents the coefficients. Given these findings we can reject Hypothesis 2 beca use drug of choice was found to be significant. Table 4-12. Logistic Regression Co efficients for Drug of Choice Step Variable Wald df p Odds CI 1 DC1 0.341 0.584 1 .445 1.406 .259-7.124 DC2 0.097 0.053 1 .818 1.102 .118-5.404 DC3 0.831 4.050 1 .044 2.296 .697-116.220 DC4 1.398 1.103 1 0.205 4.048 DC5 20.095 0.000 1 1.000 Hypothesis 3 : There is no relationship between suc cessful completion of Dependency Drug Court and participants frequency of drug use. Logistic regression was conducted for the group ed variable: frequency of use (FU). The dependent variable was the dichotomous variab le of successful or unsuccessful treatment completion derived from the stage of treatment with phases one to four being unsuccessful and successful completion. Among the grouped variable frequency of use (FU), no categories were found to be statistically signifi cant. When comparing the pred icted values for the dependent variable based on the logistic regression model with the actual observed values of data in 81

PAGE 82

participants frequency of use, the final m odel i ndicated 81.6% of the participants were correctly identified or predicted in thei r groups by the model. Table 4-13 presents the coefficients. Given these findings, we failed to reject Hypothesi s 3 as frequency of use was not found to be significant. Table 4-13. Logistic Regression Coe fficients for Frequency of Use Step Variable Wald df p Odds CI 1 FU1 -20.287 0.008 1 .999 0.000 .386-18 FU2 -19.677 0.000 1 .999 0.000 .524-22 FU3 -20.104 4.353 1 .999 0.000 .430-20 FU4 -18.564 1.646 1 .999 0.000 FU5 -19.306 2.502 1 .999 0.000 Hypothesis 4 : There is no relationship between suc cessful completion of Dependency Drug Court and participants treatment history prior to program admission. Logistic regression was conducted for the gr ouped variable: prior treatment (PT). The dependent variable was the dichotomous variab le of successful or unsuccessful treatment completion derived from the stage of treatment with phases one to four being unsuccessful and successful completion. Among the grouped variable of prior treatment, no categories were found to be statistically significant. When comparing the predicted values for the dependent variable based on the logistic regression model with the ac tual observed values of data in participants prior treatment, the final model indicated 81.6% of the participants were correctly identified or predicted in their groups by the model. Table 4-14 presents the coefficients. Given these findings, we failed to reject H ypothesis 4 as prior treatment wa s not found to be significant. 82

PAGE 83

Table 4-14. Logistic Regression Co efficients for Prior T reatment Step Variable Wald df p Odds CI 1 PT0 -0.577 61.687 1 .448 0.562 .049-27.196 PT1 -0.825 1.000 1 .223 0.438 .000-* PT2 -0.697 1.000 1 .335 0.498 .003-0.837 PT3 -1.092 1 .095 0.335 .011-2.565 PT4 -1.055 1 .275 0.348 .073-1.323 PT5 -0.298 1 .745 0.743 Hypothesis 5 : There is no relationship between suc cessful completion of Dependency Drug Court and criminal status of the part icipant at time of program admission. Logistic regression was conducted for the group ed variable: criminal status (CS). The dependent variable was the dichotomous variab le of successful or unsuccessful treatment completion derived from the stage of treatment with phases one to four being unsuccessful and successful completion. Among the grouped variable criminal status, no categories were found to be statistically significant. When comparing the predicted valu es for the dependent variable based on the logistic regression model with the ac tual observed values of data in participants criminal status, the final model indicated 81.6% of the participants were correctly identified or predicted in their groups by the model. Table 4-15 presents the coefficients. Because criminal status was not found to be significant, we failed to reject Hypothesis 5. 83

PAGE 84

Table 4-15. Logistic Regression Coe fficients for Crim inal Status Step Variable Wald df p Odds CI 1 CS1 0.981 0.000 1 .320 2.667 .587-3.368 CS2 1.232 0.000 1 .199 3.429 .483-2.514 CS3 1.086 0.000 1 .985 2.963 1.022-5.158 CS4* Hypothesis 6 : There is no relationship between suc cessful completion of Dependency Drug Court and sources of social support among pa rticipants at time of program admission. Logistic regression was conducted for the group ed variable: social support (SS). The dependent variable was the dichotomous variab le of successful or unsuccessful treatment completion derived from the stage of treatment with phases one to four being unsuccessful and successful completion. Among the grouped vari able social support, support from friend/family/spouse/partner was found to be a statis tically significant predic tor of social support. When comparing the predicted values for the dependent variable based on the logistic regression model with the actual observ ed values of data in participants sources of social support, the final model indicated 81.6% of the participants were correctly identifie d or predicted in their groups by the model. Table 4-16 presents the coefficients Given these findings we reject Hypothesis 6. Social support was found to be significant. 84

PAGE 85

Table 4-16. Logistic Regression Co efficients for Social Support Step Variable Wald df p Odds CI 1 SS1 0.140 0.008 1 .931 1.154 .386-18.419 SS2 18.268 0.000 1 .997 .524-22 SS3 -2.934 4.353 1 .037 0.053 .430-20.409 SS4 -1.784 1.646 1 .200 0.168 SS5 -1.171 2.502 1 .114 0.310 Hypothesis 7 : There is no relationship between su ccessful completion of Dependency Drug Court and participants prior involveme nt with Child Protective Services. Logistic regression was conducted for the group ed variable: prior ch ild protective service involvement (CP). The dependent variable was the dichotomous variable of successful or unsuccessful treatment completion derived from the stage of treatment with discharge from phases one to four classified as unsuccessful completion and completion of phase IV as successful completion. Among the grouped variable prior involvement w ith child protective services, no categories were found to be statistically si gnificant. When comparing the predicted values for the dependent variable based on the lo gistic regression model with the actual observed values of data in participant s prior involvement with Child Protective Services, the final model indicated 81.6% of the participan ts were correctly identified or predicted in their groups by the model. Table 4-17 presents the coefficients. B ecause prior involvement with child protective services was not found to be significant we failed to reject Hypothesis 7. 85

PAGE 86

Table 4-17. Logistic Regression Coefficients for Prior Child Protective S ervice Involvement Step Variable Wald df p Odds CI 1 CP1 0.307 0.000 1 .717 1.359 .259-7.124 CP2 -0.223 0.000 1 .819 0.800 .118-5.404 CP3 2.197 0.000 1 .092 9.000 .697-116.220 CP4 -3.379 0.000 1 .092 0.034 Summary of Findings In this study, the majority of participants were un successfully discharged in phase I ( N =121, 65.4%) of the DDC program, followed by thos e participants discharged in phase II (N=16, 8.6%), phase III ( N =7, 3.8%) or in phase IV ( N =7, 3.8%). Thirty-four participants (18.4%) successfully comple ted the DDC program. There were more females ( N =163, 88.1%) admitted to the Dependency Drug Court program than males ( N =22, 11.9%). In the total sample, participants were evenly distributed across ag e groups with 49 participants (26.5%) between 1825 years of age, 46 participants (24.9%) betw een 26-30 years of age, 44 participants (23.8%) between 31-36 years of age, and 46 particip ants (24.9%) 37 years of age or more. Among the demographic information (age, gender race, and education) collected, age was found to be a variable associated with succe ssful and unsuccessful completion of Dependency Drug Court. The majority of participants who su ccessfully completed were thirty-seven years of age or older (38.2%) and between 31-36 years old (32.4%). Participants under age thirty were less likely to successful complete with 14.7% completing between 26-30 years of age and 18-25 years of age. No significant differences were found by partic ipants racial group or educational level. The racial/ethnic composition of the study c onsisted of 88 African-Americans (47.6%), 92 86

PAGE 87

Caucasians (49.7%), two Hispanics (1.1%), two m ixed ethnic (1.1%), and one American Indian (.5%). None of the participants identified th emselves as Asian-American. Ninety-five (51.4%) of the participants reported having less than a high school diploma, fi fty-four (29.2%) reported having a high school diploma, 26 (14.1%) reported having some college, seven (3.8%) reported having an Associates Degree, and three (1.6%) reported having a Bachelors Degree. There were no participants who had earned gradua te degrees (Masters or Doctoral). Of the variables under examination in this study, significances were reported by successful and unsuccessful participants in the sources of soci al support. However, Chi Square findings may be invalid as there were cells with counts of less than five. The majority of participants ( N =31, 91.2%) who successfully completed the program reported receiving social support from friends/family/spouse/partner, followed by support from other institutions ( N =9, 26.5%), and support from support groups ( N =3, 8.8%). There were two part icipants (5.9%) successfully completing reporting no social support system ( N =60). None of the part icipants successfully completed reporting they were in serious conflict with and/or had been pressured to receive treatment by their support system. The participants of the study did not have a great deal of prior CPS involvement with 132 (71.4%) reporting one prior open case with Child Protective Services. However, there were significant differences in the level of involvement with child protective services. Among the successful completers, 26 (76.5%) reported one prior open case, five (14.7%) reported two prior open cases, one (2.9%) reported three prio r open cases, and two (5.9%) repo rted prior termination of parental rights. While the Chi Square analysis revealed signi ficant differences for prior child protective services (CPS) involvement among participants reporting three prior open cases and for sources of social support, regression analysis did not reveal signif icant differences for prior CPS 87

PAGE 88

88 involvement. The findings of the hierarchical lo gistic regression using the summed incidents of criminal status, drug of choice, frequency of us e, prior CPS involvement, prior treatment history, and sources of social support found only the summe d drug of choice, prior treatment history, and social support were statistically significant predic tors of successful or unsuccessful treatment. As a result, we failed to reject Hypothesis 1. Logistic regression was also completed for each set of predictor variab les criminal status, drug of choice, frequency of use, prior CPS i nvolvement, prior treatmen t history, and social support. There were no significant predictors of successful or unsuccessful outcome for frequency of use, prior treatment, criminal stat us, and prior CPS involvement. Therefore, we failed to reject Hypotheses 3, 4, 5, and 7. Ho wever, marijuana (DC3) was found to be a statistically significant predicto r of drug of choice and support from friend/family/spouse/partner was found to be a statistically si gnificant predictor of social support. As a result, we reject Hypotheses 2 and 6. Chapter 4 presented the findings of the analys is of the data for the study. The study group was described and descriptive characteristics articulated. Analysis of the data for the research questions was presented and statistically significant models noted.

PAGE 89

CHAP TER 5 DISCUSSION The examination of treatment drug courts, fa mily treatment drug courts specifically, has been of growing interest over the past few years. To further explore issues contributing to successful completion, this research examined seven variables believed to be relevant to successful completion of Dependency Drug Court in the 8th Judicial Circuit. Specifically, the study examined the extent to which the variables of criminal status, drug of choice, frequency of use, child protective services (CPS) involvement, prior treatment, and source of social support were associated with successful completion by participants of a family treatment drug court program. This chapter includes a discussion of the limitations of the study and the research findings related to each study hypotheses. Implications for future researc h, theory, and practice are also provided along with recommendations for future research. Limitations There are some inherent limitati ons in using archival data. Due to the archival nature of this study, this investigation did not lend itself to the purposeful collection of data nor allow for adding more research participants. Data obtai ned from the study was limited to existing data generated from a common assessment protocol. Although standardized evaluation documents were used at the treatment facility, clinical interpretation of variables was determined by the evaluating clinician. There we re 6 clinicians from January 19, 2001 and January 1, 2008 who used this protocol which lends itself to 6 possi ble diagnostic interpretations and evaluations. For example, determination of number of relapses for participants throughout their participation in the program could not be accurate ly gathered as documentation of these occurrences varied among treatment clinicians. While some clinicians documented relapse by each occurrence, 89

PAGE 90

som e documented relapse by number of times each pa rticipant restarted a phase of the treatment program. Accuracy of assessment of the variables (i.e ., drug of choice, frequency of drug use, treatment history, and criminal status) was also dependent on the full disclosure of program participants at the time of their evaluation. However, particip ants who had lost custody of their children may have been guarded at the time of their evaluation and theref ore reluctant to fully disclose information they believed would be ha rmful to their custody cas e. Although there were participants who became therapeutically engaged during their participation in the DDC program and provided more accurate self-reports later in treatment, data for this study only included information obtained at the point of entry. There was also the potential for rater bias on the part on the investig ators in assessing and coding the data, as both raters had prior knowle dge and/or experience in working with this population. The raters may have coded data based on prior knowledge and experience in working with this population. In addition, alth ough standardized evaluation documents were used at the agency under study, these documents we re revised in 2003 and 2005. As a result, the investigator found that some of the evaluation qu estions were reworded, deleted, or substituted. While the investigator was able to locate the ne cessary information to code the data, rewording of evaluation questions could infl uence the reliability of partic ipant responses. In addition, outcomes of the data were based solely on the se lf-report of participants at the time of their clinical assessment. Moreover, the coding of data was based only on information collected at the time of the participants evaluation; therefore, accuracy of responses could not be verified. Furthermore, the data analytic procedures used in this study could be improved upon. Hierarchical logistic regression analysis was used because it fit most with the archival nature of 90

PAGE 91

the study. However, certain independent variab les, such as sources of social support, had mutually ex clusive response categories thus usin g summed data for this variable may not have been appropriate for the regressi on model. Therefore, logistic regression was conducted for each separate category (criminal status drug of choice, frequency of use, child protective services (CPS) involvement, prior treatment, and source of social support). There was also a substantial difference in the number of unsuccessful completers ( N =151) and successful completers ( N =34). This unequal group size may not have allowe d for accurate comparison of the groups. Finally, the Dependency Drug C ourt program structure/design has remained consistent over time, however, the composition of the DDC t eam has changed multiple times as individual staff have changed. The DDC team is responsib le for evaluating successful and unsuccessful completion of program participants, therefore, ch anges in team membership may have influenced evaluation and discharge criteria from partic ipant to participant. In addition, DDC team membership may have influenced the nature of admission and treatment protocols for the program. For example, the DDC program made changes in their admission criteria between 2004 and 2007 resulting in an increase in the numbe r of participants ad mitted to the program during this period. Discussion of Findings Drug of choice, prior treatment, and sources of social support were f ound to be significant indicators of successful and unsuccessful completion of participants of the DDC program. Significantly more unsuccessful completers ( N =78, 51.7%) than successful completers ( N =12, 35.3%) identified marijuana as their drug of choice. In contra st, more successful completers as compared to unsuccessful completers reported cocaine ( N =23) as their drug of choice, followed by alcohol ( N =18), marijuana N =12), opiates ( N =1), and heroin ( N =0). This is inconsistent with national data collected by the Substance Abuse and Mental Health Services Administration 91

PAGE 92

(SAMHSA) (2004), which found that more (36%) clien ts who were successfully discharged from intensive outpatient treatment reported al cohol as their drug of choice at admission, followed by marijuana (22%), cocaine (18 %), opiates (10%), and ot her substances (2%). SAMHSA (2004) also found that clients who report ed marijuana as their primary substance had stayed in treatment for the longest length of time and were more successful among intensive outpatient participants (60 days), while clients who reported cocaine had the shortest stay and were less successful (48 days). For the prior treatment variables, there were more unsuccessful than successful completers who reported no prior treatment history (N =81). In contrast, there were fewer unsuccessful than successful completers who reported more than one outpatient admission ( N =9). There were more successful than unsuccessful who reported no prior treatment history ( N =14) and fewer successful completers who reported more than one outpatient admission ( N =3) or more than one residential admission ( N =3). This finding is consistent with data gathered by SAMHSA (2004) which found that clients with fewe r prior treatment episodes were more likely to complete intensive outpatient treatment than were clients with more prior treatment episodes. However, research has shown that the majority of substance dependent i ndividuals only achieve stable recovery after 3 to 4 treatment episod es over multiple years (Anglin, Hser, & Grella, 1997). Source of social support was the most si gnificant indicator of successful versus unsuccessful completion of the family treatment drug court program under study. Successful completers reported more social support from support groups (AA/NA) (8.8%), 26.5% reported receiving support from other in stitutions, and 91.2% reported r eceiving social support from friends/family/spouse/partner. In contrast, onl y 5.9% of the successful participants reported 92

PAGE 93

having no social support system and none of them reported that they were in serious conflict with and/or having been pressured to receive trea tment by ones support system. Moos & Moos (2007) found that family and social resources were strong predictors of positive outcomes among substance dependent individuals. They also f ound that participants achieved long-term positive outcomes following treatment through developing a nd enhancing protective resources such as financial resources, better heal th, and participation in AA (Moos & Moos, 2007). Because research has demonstrated that addiction treatment outcomes can be compromised by the lack of sustained recovery support servic es (White & Kurtz, 2006) it is imperative that family treatment drug court programs examine how they might strengthen the support systems of program participants Although no significance was found for participants who repor ted having one prior case, two prior cases, and termination of parental righ ts for CPS involvement; a significant difference was reported between successful and unsuccessful completers with unsuccessful completers more likely to have three prior cases ( N =27, 17.9%) than successful completers ( N =1, 2.9%). There were also more successful completers wh o reported having only one prior case with CPS ( N =26, 76.5%), or two prior open cases ( N =5, 14.7%). This is cons istent with past research which has found that successful completers ha ve significantly less i nvolvement with child protective services (Kell y, Blacksin, & Mason, 2001). Age was also found to be a significant indicator of successful completion as the majority of participants who successfully comp leted their treatment were either thirty-seven years of age or older (38.2%) or between 31-36 year s old (32.4%). In this study, participants under age thirty were less likely to successfully complete as only 14.7% of the participants who completed the program were between the ages of 26 to 30 and of 18 to 25. It was not anticipated that there 93

PAGE 94

would be differences in successful completion by age as clien ts were evenly distributed across categories of age. However, this finding unders cores the need to look at ways of improving program structure to increase the rate of succe ssful completion among participants under age 30. Implications Results from this study have contributed to an increased understa nding regarding those factors which influence successful completion of family treatment drug court. While there are not significant differences there are trends that need further examination. Although several of the predictor variables examined in this study did not achie ve statistical significance for the criterion successful and unsu ccessful completion, significance was reported for the following variables: drug of choice, prior treatment, CPS involvement, and s ources of social support. Age was also found to differentiate su ccessful from unsuccessful completers of the Family Treatment Drug Court program. These findings suggest that th eorists, researchers, and practitioners should consider these factors when conceptualizing th e factors affecting suc cessful and unsuccessful completion of family treatment drug courts and when developing programs for this population. The influence of drug of choi ce on participants of family treatment drug court programs needs further investigation to determine the extent to which a participants primary drug of choice impacts their successful or unsuccessful completion of treatment. The findings of this study showed marked differences between succes sful completion of the Dependency Drug Court program, an intensive outpatient treatment progr am, and national data on successful completion rates of intensive outpatient programs. There was a significant difference between successful completers ( N =12, 35.3%) and unsuccessful completers (N =78, 51.7%) who identified marijuana as their drug of choice. In contrast, the succe ssful completers reported cocaine as their drug of choice. Research has found that more client s successfully complete intensive outpatient treatment who report alcohol as their drug of choice (SAMHSA, 2004). Further study is needed 94

PAGE 95

to exam ine possible differences between particip ants of family treatment drug court programs and participants of other inte nsive outpatient programs. Findings of this study also suggest that resear chers, practitioners, and program developers of family treatment drug court programs might benefit from examining the prior treatment history of program participants when determining admission criteria and program design. When examining the differences between program par ticipants with no prior treatment history and participants with one or more treatment episodes, there more unsuccessful completers among participants with no prior treatment history. Practitioners need further information on the viability of individuals successf ully completing family treatment drug court programs who have had no history of treatment. Th ese individuals may be more appr opriate for less intensive forms of treatment while family treatment drug court pr ogram may need to be reserved for individuals with more extensive treatment experience. Involvement with child protective services also showed significance for participan ts who reported three prior open cases. This may suggest that participants who have a history of prior cases may need an alte rnative treatment program and/or if additional services to assist them in ach ieving successful completion outcomes within the family treatment drug court program. In addition, researchers, practit ioners, and program developers of family treatment drug court programs should consider social support as an indicator of a participan ts likelihood of successfully completing this program and look for ways of improving and/or enhancing the participants social support systems to assist them in reaching successful completion outcomes. Many family treatment drug court programs have pr ogram requirements that require participants to strengthen their recovery support system s through support group (AA/NA) attendance and obtainment of a 12-step sponsor. In addition, some require partic ipants to obtain and maintain 95

PAGE 96

em ployment to demonstrate self-sufficiency a nd the ability to provide for their child(ren). However some programs, such as the program under study, incorporate these requirements at later stages of the treatment program which may lessen the impact these sources of support may have on participants in the early stages of their treatment. The importance of certain sources of social support indicated by the data, suggests the need to thor oughly assess the participants social support system prior to their admission to determine what servic es and assistance is needed at treatment onset to incr ease successful completion outcomes. Data also suggests that res earchers and practitioners shoul d look more closely at which factors may contribute to successful comple tion of family treatment drug court among participants over 30 years of age as compared wi th those under 30 years of age. In this study, there were more unsuccessful completers who were under 30 years of age. These participants may require alternative treatment approaches (i.e. treatment gr oups for young adults) to assist them in reaching successful completion outcomes. Further exploration is needed to determine which interventions are more effective with this population. In addition, data reported in this study was c onsistent with research which has shown that the longer a participant spends in treatment the greater their chances for a favorable treatment outcome (Peters & Murrin, 1998, Lawental et al, 1996, Trone & Young, 1996). However, the majority of the study participants were discharged in phase I or phase II with a majority of participants being discharged in phase I (N=121, 80.1). Only 18.4% (N=34) of the study participants in the study successfully complete d the Dependency Drug Court program. This low rate (18.4%) of successful completion of this fa mily treatment drug court program is of great concern. SAMHSA (2004) found that approximately 40% of individuals who participate in intensive outpatient treatment programs complete it successfully. The family treatment drug 96

PAGE 97

court program under study m ay ha ve differed from the treatment programs examined in the SAMHSA study as there are vari ations in the duration and design of intensive outpatient programs. However, more information is needed to determine if there ar e distinct differences among family treatment drug court participants a nd participants of other types of intensive outpatient treatment programs. Furthermore, re searchers and practitione rs should continue to look at ways of improving client retention with in family treatment drug court programs to increase the likelihood of participants obtaining successful completion outcomes. Recommendations for Future Research More research is needed on both participants and practitione rs of Family Treatment Drug Court (FTDC) programs to improve the effectiven ess of these programs. Reproduction of this study would entail a redesign of the methodol ogy conducted. Qualitative methods would be incorporated which would include focus groups a nd in-depth interviews of subsets of FTDC participants and practitio ners who provide clinical treatment to this population. The purpose of the interviews would be to obt ain qualitative data regarding which components of the FTDC program participants found either helped and/ or hindered their success in the program. For example, age was a variable found to signifi cantly differentiate between successful and unsuccessful completers. There were more succe ssful completers among pa rticipants 37 years of age or older or between 31-36 years of age, a nd fewer successful completers for participants under 30 years of age. Interviews could be conducted with a subset of participants over 30 years of age and under 30 years of age to examine whic h interventions of the program contributed to their successful or unsuccessful continuation/completion of treatment. Inquiries would also be conducted on the characteristics of these diffe rent age groups which may influence their treatment outcomes. 97

PAGE 98

Prior to conducting the study, a focus group w ould be held with practitioners of FTDC programs to examine their beliefs on which clie nt characteristics may influence successful completion of these programs. Variables included in the original study may be omitted as practitioners may identify different variables believed to be influe ntial in treatment outcomes, for example, participants with co-occurring mental h ealth and substance abuse disorders. In-depth interviews would also be conducte d with practitioners that explored the nature of the work involved in FTDC programs. The lo ngevity of practitioners in this program is a concern as there were six different practitioners who provided treatment services during the time period included in this study. It is important to explore what aspects of the pr ogram and/or client characteristics may deter practitioners from continui ng to work with this population. In addition, further investigati on is needed into motivation to participate and successfully complete FTDC programs. There was an increase in the number of participants admitted to the FTDC program under study in 2004 which followed a change in admission criteria. Initially, FTDC participants who were found appropriate for the program were required to request admission to the program prior to being adm itted. However, in 2004 all participants found appropriate for the program were recommended by the court for pa rticipation resulting in some coercion of participants to particip ate. As a result, the rate of successful completers of the FTDC program under study declined. I nquiry is needed from both part icipants and practitioners to determine the extent motivation to change influe nces successful completio n of these programs. FTDC programs may be currently designed for vo luntary participants with higher levels of motivation to change. Therefore, they may not be appropriate for participants who believe they have been mandated or coerced to participate. 98

PAGE 99

Follow-up analysis and interviews could also be conducted on participants who successfully completed the program. Data could be collected at 3 months, 6 months, and 12 months following discharge from the FTDC program to determine if the participant was able to maintain abstinence. If the participant was unable to maintain abstinence, data would be collected on number of relapses which occurr ed and inquiries would be conducted on how the participant dealt with their relapse. Data woul d also be collected at 3 months, 6 months, and 12 months following discharge from the FTDC prog ram to determine is the participant had any subsequent investigations for child abuse and ne glect and investigations which resulted in the removal of their child (ren). In terviews could also be used to examine which components of the program participants believed to be helpful in continuing their sobriet y, remaining out of the child welfare system, and which components participants continue to utilize. The data from the qualitative interviews could be analyzed by means of comparative analysis. Information obtained by the FTDC participants and practitioners could be analyzed for conceptual themes or categories. This analysis could be used to detect commonalities and differences among participants and practitioners themes. The themes or categories would then be analyzed for comparisons across interviews for the purpose of generating a theory based on that data. The results of this study could be used in the development of a structured interview to assess the individuals appropriateness for participation in a Family Treatment Drug Court program. The structured interview would be tailored to individua ls involved with child protective services with identified substance abuse issues and used for the assessment of individual characteristics related to successful completion of FTDC programs, such as drug of choice, prior treatment, and sources of social support. The purposes for developing such a st ructured interview are twofold: (1) to develop a standardized interview for the assessment of FTDC participation, which can be used by trained 99

PAGE 100

professionals; and (2) to design an interview with standard probes, internal consistency, inter-rater reliability by which symptoms are clearly defined. To develop the structured interview, several questions would be writte n specific to FTDC participants. For example, questions would a ssess the source of social support reported by participants and the amount of support believed to be received by the participant. Each question would be given a set of scoring criteria and prompts to elicit information assisting in the scoring of the participants answers. After pilot testing, the number of questions would be revised to reflect any need to add or eliminate questions. A series of item and scale analyses would then be conducted to determine further need for revision. The remaining items would result in the Family Treatment Drug Court Interview (FTDCI) which would be evaluated for inter-rater, internal, and retest reliability. There are also several directi ons for research based on the results of this study. Although several of the predictor variables in this investigation (i.e., criminal status, drug of choice, frequency of use) did not achieve statistical significance for the criterion of successful completion of the family treatment drug court in this study, the finding from the variables of drug of choice, prior treatment, source of social support, and CPS involve ment (participants reporting th ree prior cases) did show significant differences. These factors require furt her exploration to examine how they influenced successful completion of family treatment drug court. In addition, age was among the demographic variables which had significant difference. There was no significant difference among partic ipants for criminal status at time of admission with similar successful completion rates for participants who had no history of criminal involvement (20.0%), participants who we re not under legal supervision at the time of admission but had at least one previous criminal change (16.3%), and participants who were under legal supervision at time of admission (18.4%). Previous researcher s have reported that drug use and criminal activity are reduced for ad ult drug court program participants while they 100

PAGE 101

are receiv ing treatment services (Belenko, 1999, 2001); however, more information is needed regarding rates of criminal activ ity and retention among family trea tment drug court participants. Longitudinal research is also n eeded to determine the lasting impact of treatment by examining which family treatment drug court participants re-offend while in family treatment drug court programs or following discharge (successful or unsuccessful). There were no significant di fferences found for drug of c hoice in this investigation. However, method of drug use (oral, inhalation, in travenous, etc.) was not distinguished for each participant. Drug of choice wa s coded by the classification of the substance reported by the participant and not the form of the substance. For example, crack cocaine was classified as cocaine and hashish was classified as marijuana. There may in fact be differences in the rates of successful completion of family treatment drug c ourt participants based on type of substance used. Some substances which are administered in travenously or free based are highly addictive. For example, researchers (Schiff & Terry, 1997) ha ve found crack cocaine use to be significantly and negatively related to completion of the drug treatment court program a nd have suggested that the use of this particular drug was an important factor in prev enting offenders from successful completion. There were no significant di fferences found in regard to gender; however, this study sample contained an overwhelming number of fema le participants (N=163) compared with male participants (N=22). Research suggests that gender differences are an important factor in addiction and recovery (Magura & Laudet, 1996). Gender differences have been reported to impact treatment initiation, retention, and comple tion. Surveys of national samples indicate that, in the general population, more fathers than mo thers have a substance abuse disorder (DHHS, 1994) and men consistently outnumber women in all types of treatmen t (Gerstein, Johnson, 101

PAGE 102

Larison, Harwood, & Fountain, 1997). However, th ere are a greater num ber of women entering treatment who are mothers (DHHS, 1999) which is evidenced by the partic ipants in this study. Men and women also differ in their alcohol and drug use and associated behaviors. For example, there are gender differences in initiatio n into substance abuse treatment, sources of referral and social support, and where they ac cess treatment (Weisner Greenfield, Room, 1995; Brennan, Moos, Kim, 1993). While men are more li kely to receive familial support for treatment initiation and referral from employers and the criminal justice system, women receive lower levels of familial support and are more often referred by social service agencies. This may account for the disparity in the number of females and males admitted to the family treatment drug court under study; however, fu rther investigation is needed to determine influences in referrals to family treatment drug court progra ms. Of those parents referred for treatment services by CPS agencies, mothers entering into treatment are more likely than fathers to be concerned about losing custody of their children and to indicate th at their treatmen t participation may affect their custody status (Grellan & Joshi, 1999; Finkleste in, 1994; Henderson, 1994). This may suggest that women require specialized services to address their unique needs and motivation for participating in treatment services, such as family-oriented services providing comprehensive care as well as parenting and fam ily skills training, all of which usually remain unaddressed in traditional drug treatment (Magura & Laudet, 1996, p. 203). In addition, researchers should begin to exam ine the impact of differences in motivation for treatment among couples (mothers & father s) who have both been identified as having alcohol and drug abuse problems. Little is known about the differences in motivation to participate in family treatment drug court prog rams for couples and/or if child protective agencies have different criteri on for referring couples to family treatment drug courts. While 102

PAGE 103

m any of the participants in th e program under study identified themselves as married or unmarried couples, more research is needed to determine what factors influence couples to complete treatment successfully. More research has now been conducted examining the impact of ethnicity/race on drug treatment. Although there were no significan t differences in treatment completion by racial/ethnic group of participants in this study; previous research findings are contradictory. For example, Schiff and Terry (1997) examined adu lt drug court treatment outcomes and found that nonwhite participants were less successful than wh ite participants. Their st udy also revealed that nonwhite offenders faced both cultural barriers and structural problems as clients of drug treatment court (Schiff & Terry, 1997). Sechrest and Shichor (2001) also reported a significant difference by ethnic group in adult drug treatm ent court outcome: 69% of the white clients graduating versus 32% of the African-American clients. However, other researchers have examined adult drug court outcomes and f ound no significant differences in treatment completion by ethnic group (Saum, Scarpitti, & Robbins, 2001; Logan, Williams, Leukefeld, & Minton, 2000). In this study, the ethnic/racial make-up of this sample was evenly split between white participants at 49.7% and persons of color at 50.3%. Successful completion of participants was also similar with 21.7% of whites successf ully completing and 15.1% of persons of color successfully completing. However, further research is needed to determin e whether there are differences in treatment outcomes for FTDCs due to ethnicity/race and to determine if more attention needs to be directed towards cultura l barriers that may impede completion rates of FTDC participants. Co-occurring mental illness and substance abuse is also a growing concern among theorists, researchers, and clinicians. Individu als with mental illness and co-occurring substance 103

PAGE 104

abuse proble ms have become a common occurrence in treatment facilities, and may contribute to treatment non-compliance (George & Krystal, 2000) Approximately 50% of individuals with psychiatric disorders will meet DS M-IV criteria for drug or alcohol abuse or dependence at some point during their lives (Dixon, 1999). Moreover, co-morbid substance abuse and mental illness may contribute to noncompliance and treatment -resistance to pharmacologic and psychosocial treatments (George & Krystal, 2000). As a result, more and more programs have begun to integrate mental health and addiction treatment to improve outcomes for their clients. Questions have been raised however, regardi ng the effectiveness of treating individuals with mental illness and co-occurring substance abuse disorders in the same programs as individuals having only substance abuse disorders. Mental illness and co-occurring disorders was not a variable under study in th is investigation; how ever, research has shown that those with mental illness fare as well in drug and alcohol treatment programs (Galanter, Egelko, Edwards, & Katz, 1996). There have been advancements in the establishment of co-occurring treatment programs; however, there are few studies on the retention rates of individuals with co-occurring disorders in Family Treatment Drug Courts. Furthe r research is needed to determine whether the rates of successful treatment completion is affect ed by parents with co-occurring mental illness as compared with those with substan ce abuse disorder diagnoses only. Summary The prediction of successful completion of fa mily treatment drug court was examined by means of participants drug of choice, frequency of use, prior treatment history, criminal history, source of social support, and pr ior involvement with child prot ective services. In addition, demographic information (age, gender, race, and education) was also gathered to determine if there were demographic differences between su ccessful and unsuccessful participants. A hierarchical logistic regression an alysis revealed that drug of choi ce, prior treatment, and social 104

PAGE 105

105 support were significant predictor variables. A Chi square analysis also revealed that child protective service involvement significantly differentiated betw een successful and unsuccessful participants. Age was also found to be signi ficant with more successful completers among participants between 31-36 years of age and 37+ years of age. The results of this study have implications for theory, practice, and research, and especially future research into family treatment drug courts. Substance abuse clinicians will be better able to design effective treatment interventions when they have gr eater knowledge and understanding of the factors which impact successful and unsuccessful comple tion of family treatment drug court programs.

PAGE 106

APPENDIX A DATA CODING No = 0 Yes = 1 Criminal Status : A four point rating scale will be used to m easure criminal status: CS 1. 0 = no history of criminal involvement 2 1 = participant not under legal supervisi on at the time of admi ssion but at least one previous criminal charge 3 2 = participant under legal supe rvision at the time of admission 4 3 = participant under legal supervision at the time of admission and concurrently admitted to Adult Drug Court program Drug of Choice: A five point rating scale will be used indicating dependence: DC 1 = cocaine 2 = alcohol 3 = marijuana 4 = opiates 5 = heroin Frequency of Use: A five point rating scale: FU 1 = No past month use 2 = 1 to 3 times in past month 3 = 1to 2 times per week 4 = 3 to 6 times per week 5 = Daily use Prior CPS Involvement: Four point scale will measure prior Child Protective Service involvement: CP 1 = All parents who had have had one prior op en case with the Depa rtment of Children & Families (whether the case was closed or not) 2 = Two prior cases 3 = Three prior cases 4 = Termination of parental rights Prior Treatment History: Six point scale regarding prior treatment: PT 0 = No prior treatment history 1 = One treatment admission (succes sful or unsuccessful completion) in a traditional outpatient program (once a week for 3 months of treatment minimum) 106

PAGE 107

107 2 = One treatment admission in intensive outpatient treatment (3-5 days a week for 3 months of treatment minimum) 3 = One treatment admission in residential treatment (28 days minimum) 4 = More than one outpatient treatment admi ssion (outpatient or in tensive outpatient) 5 = More than one residential admission will be coded as 5. Social Support: Five categories: SS 1 = Having no social support system 2 = In serious conflict with and/or having been pressured to receive treatment by ones support system 3 = Support from friends/family, spouse/partner 4 = Support from support groups (AA/NA) 5 = Support from other institutions (i.e. employer) Stage of Treatment: Participants phase of the DDC program at the time of discharge (five point rating scale): ST 1 = Phase I 2 = Phase II 3 = Phase III 4 = Phase IV 5 = Successful Completion

PAGE 108

REFERENCE LIST Alleyne, B.C., Stuart, P., & Copes, R. (1991). Alcohol and other Drug U se in Occupational Fatalities. Journal of Occupational Medicine. 33 (4). 496-500. Alterman, A.I., McClellan, A.T., OBrien, C.P., August, D.S., Snider, E.C., Droba, M., Cornish, J.W., Hall, C.P., Raphaelson, A.H., & Schrad e, F. (1994). Effectiveness and cost of inpatient versus day hosp ital cocaine rehabilitation. Journal of Nervous and Mental Disease, 182, 157-163. Anglin, M.D. & Hser, Y. (1992). Drug Abuse Treatment in: Watson, R.R., ed. Drug and Alcohol Abuse Reviews. Vol. 4, Drug Abuse Treatment. Totowa, NJ: Human Press. Anglin, M.D., Hser, Y, & Grella, C.E. (1997). Drug Addiction and Treatment Careers Among Clients in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors. 11(4), 308-323. Badeau, Sue. Child Welfare and the Courts. Retrieved October 7, 2007, http://pewfostercare.org/research/docs/BadeauPaper.pdf Behnke, M., Eyler, F.D., W oods, N.S., Wobie, K. & Conlon, M. (1997). Rural pregnant cocaine users: An in-depth socio-demographic comparison. Journal of Drug Issues. 27(3), 501524. Belenko, S. (2002). Drug courts. In C. G. Leukefeld, F. Tims, & D. Farabee (Eds.), Treatment of drug offenders: Polici es and issues (pp. 301-318). New York: Springer. Belenko, S. & Peugh, J. (2005). Estimating Drug Treat ment Needs among State Prison Inmates. Drug and Alcohol Dependence, 77(3), p. 269-281. Blume, S.B. (1998). Clinical text book of addictive disorders: A ddictive Disorders in Women (p. 413-429). New York, NY: Guilford Press. Brennan, P.L., Moos, R. H., & Kim, J. Y. (1993). Gender differences in the individual characteristics and life contexts of la te-middle-aged and older problem drinkers, Addiction. 88, 781-790. Brown, B.S. (1997). Staffing pattern s and services for the war on drugs. In J.A. Egerston, D.M. Fox, & A.I. Leshner (Eds). Treating drug abusers effectively (p. 99-124). Malden, MA: Blackwell Publishers. Butzin, C.A., Saum, C.A., & Scarpitti, F.R. (2002) Factors associated with completion of a drug treatment court diversion program Substance Use & Misuse. 37, 1615-1633. Califano, J.A. (2007). High Societ y: How Substance Abuse Ravage s America and What to Do About It. Cambridge, MA: Perseus Books Group. 108

PAGE 109

CASA, No Safe Haven: Children of substa nce-abusing parents (New York: 1999), 23. Castellani, B., Wedgeworth R., Wooten, E., & Rugle, L. (1997). A bi-directional theory of addiction: examining coping and the fact ors related to substa nce relapse. Addict. Behav. 22(1). 139-144. Child Welfare Information Gateway, Substance abuse and child maltreatment (Washington, DC: DHHS, Administration for Children and Families, 2003). Child Welfare League of America, Nati onal fact sheet2006, retrieved October 7, 2007, http://www.cwla.org Child W elfare League of America, Nati onal fact sheet2007, retrieved October 7, 2007, http://www.cwla.org Cohen, M. (2000). Counseling Addicted W omen: A Practical Guide. Thousand Oaks, CA: Sage. Cook, R. & Schlenger, W. (2004). Prevention of Substance Abuse in the Workplace: Review of Research on the Delivery of Services. J ournal of Primary Prevention. 23 (1). 115-142. Cooper, C. S. (2000). 2000 drug court survey report: Program operations, services and participant perspectives. Wash ington, DC: U.S. Department of Justice, Bureau of Justice Statistics. Cooper, Caroline S., & Shanie Bartlett (1998). J uvenile and Family Drug Courts: Profile of Program Characteristics and Implementa tion Issues. Prepared by the Drug Court Clearinghouse and Technical As sistance Project, American Un iversity. Office of Justice Programs, U.S. Department of Justice: Washington, D.C. Cooper, C.S., & Bartlett, S. (1998). Juvenile and Family Drug Courts: profile of program characteristics and implementation issues. American University (Washington, D.C.). Office of Justice Programs Drug Court Clearinghouse and Technical Assistance Project. Copeland, J. & Hall, W. (1992). A comparison of predictors of treatment drop-out of women seeking drug and alcohol treatment in a specialist womans and two traditional mix-sexed treatment services. British Journal of Addiction. 87, 883-890. Courtney, M.E. (1998). The Costs of Child Protec tion in the Context of Welfare Reform. Future of Children. 8(1), 88-103. De Leon, G., Melnick, G., & Kressel D. (1997) ; Motivation and Readin ess for Therapeutic Community Treatment among Cocaine and Ot her Drug Abusers. American Journal of Drug and Alcohol Abuse, (23). Diclemente, C. & Scott, C. (1997). Stages of Change: Interactions with Treatment Compliance and Involvement. NIDA Monograph. 131-156. Dixon L. (1999). Dual diagnosis of substance ab use and schizophrenia: prevalence and impact on outcomes. Schizophr Res. 35:93-100. 109

PAGE 110

Dobkin, P.L., De Civita, M., Parherakis, A., & G ill, K. (2001 ). The role of functional social support in treatment retention and outcomes among outpatient adult substance abusers. Addiction. 97, 347-356. Durrant, R. & Thakker, J. (2003). Substance Use & Abuse: Cultural and Historical Perspectives. Thousand Oaks, CA: Sage. Edwards, L.P. & Ray, J.A. (2005). Judicial Pe rspectives on Family Treatment Drug Courts, Juvenile and Family Court Journal, Summer 2005. Emrick, C.D., Tonigan, J.S., Montgomery, H., & Little, L. Alcoholics Anonymous: What is currently known? In: McCrady, B.S., and Miller, W.R., eds. Research on Alcoholics Anonymous. New Brunswick, NJ: Rutgers Center for Alcoholic studies. 41-76. Erickson, J.R., Stevens, S., McKn ight, P., & Figueredo, A.J. (1995). Willingness for Treatment as a Predictor of Retention and Outcome. Journal of Addictive Diseases. 14(4), p.135150. Feig, L. (1998). Understanding the problem: Th e gap between substance abuse programs and child welfare services. In: Hampton, R.L.; Senatore, V.; & Gullota, T.P., eds. Substance Abuse, Family Violence, and Ch ild Welfare: Bridging Perspectives. Thousand Oaks, CA: Sage Publications, p. 62-95. Finklestein, N. (1994). Treatment issues for alcohol and drug de pendent pregnant and parenting women. Health and Social Work, 19 ,7. Fisher, G. L. & Harrison, T.C. (2000). Substa nce Abuse: Information for School Counselors, Social Workers, Therapists, and Counse lors. Needham Heights: MA: Allyn & Bacon. Fulton Hora, P. (2002). A Dozen Years of Drug Treatment Courts: Uncovering our Theoretical Foundation and the Construction of a Mainstre am Paradigm. Thomas Scientific, 37(13), 1469-1488). Gahlinger, P. (2004). Illegal drugs: A complete gui de to their history, chemistry, use and abuse. New York: Plume. Galanter, M. (1993) Network therapy for addic tion: a model for office practice. American Journal of Psychiatry, 150, 28. Galanter, M., Egelko, S., Edwards, H. & Katz, S. (1996). Can cocaine addict s with severe mental illness be treated along with singly diagnosed addicts?. American Journal of Drug and Alcohol Abuse. 497(11). George, T.P. & Krystal, J.H. (2000). Comorbidity of psychiatric and substance abuse disorders. Current Opinion in Psychiatry. 13(3), 327-331. 110

PAGE 111

Gerstein, D.R., Johnson, R.A., Larison, C.L., Ha rwood, H.J., & Fountain, D. (1998). Alcohol and Other Drug Treatment for Parents and We lfare Recipients: Outcomes, Costs, and Benefits. Washington, DC: U.S. Department of Health and Human Services. Golden, S.J., Khantzian, E.J., & McAuliffe, W.E. (1994). Group Therapy. In M. Galanter (Ed.), Substance abuse treatment (pp.303-315). New York: American Psychiatric Press. Goldkamp, J.S., White, M.D., & Robinson, J.B. ( 2001). Do drug courts work ? Getting inside the drug court black box. Journal of Drug Issues. 31, 27-72. Goodman, A. & Harrell, A. (1999). Review of Specialized Family Drug Courts: Key Issues Handling Child Abuse and Neglect Cases. U.S. Department of Justice: Washington, D.C. Gossop, M., Stewart, D., & Marsden, J. (2007) Readiness for change and drug use outcomes after treatment. Addiction 102 (2), 301. Green, B. L., Rockhill, A. & Furrer, C. J. (in press). Does substance abuse treatment make a difference for child welfare case outcome s? Children and Youth Services Review. Gregoire, K. A. & Schultz, D. J. (2001). Substanc e-abusing child welfare parents: Treatment and child placement outcomes. Child Welfare, 80(4), 433-452. Grella, C.E., & Joshi, V. (1999) Gender differences in drug tr eatment careers among clients in the National Drug Abuse Treatment Outcom e Study. Am. J. Drug Alcohol Abuse. 25(3), 385-406. Hall, J. (1993), What really worked? A case analysis and discussion of confrontational intervention of substance abuse in marg inalized women. Archives of Psychiatric Hardin, M. (1998). Impact of the Adoption and Safe Families Act on Judicial Resource and Procedure. Washington, DC : American Bar Association. Hartwell, S.W. (1998). Treatment-seeking patterns of chronic recidivists. Qualitative Health Research, 8(4), 481-494. Henderson, D., Boyd, C., & Mieczkowski, T. (1994) Gender, relationships and crack cocaine. Research in Nursing and Health. 17, 265. Hohman, M.M., Shillington, A.M., & Baxter, H. G. (2003). A comparison of pregnant women presenting for alcohol and other drug trea tment by CPS status, Child Abuse & Neglect 27 (3), pp. 303. Howard, J. (2004). Substance Abuse Treatment for Persons with Child Abuse and Neglect Issues: Treatment Improvement Protocol (TIP ) Series 36. Rockville, MD: Department of Health and Human Services. 111

PAGE 112

Hser, Y., Anglin, M.D., Grella, C., L ongshore, D. Prendergast, M. (1997). Drug treatment careers: A conceptual framework and existi ng research findings. Journal of Substance Abuse Treatment. 14(6), 543-558. Hubbard, R.L., Marsden, M.E., Rachal, J. V., Harwood, H.L., Cavanaugh, E.R., & Ginzburg, H.M. (1989). Drug abuse treatment: A natural study of effectiveness. Chapel Hill: The University of North Carolina Press. Huselid, R. F., Self, E. A. & Gutierres, S. E. (1991) Predictors of successful completion of a halfway-house program for chemically-dep endent women. American Journal of Drug and Alcohol Abuse, 17, 89. Kaufman, E. (1994). Psychotherapy of addicted persons. New York: Guilford Press. Kearney, M.H., Murphy, S., & Rosenbaum, M. (1994). Mothering on crack cocaine. Social Science Medicine. San Francisco, CA: Institute of Scientific Analysis. Kelly, P.J., Blacksin, B., & Mason, E. (2001). Factors Effecting Substance Abuse Treatment Completion for Women. Issues in Mental Health Nursing. San An tonio, TX: Taylor & Francis. Kropenske, V. & Howard, J. (1994). Protecting Children in Substance-Abusing Families: The User Manual Series. Washington, DC: U.S. De partment of Health and Human Services, National Center on Child Abuse and Neglect. Lawental, E., McLellan, A.T., Gr issom, G.R., Brill, P., & OBrien, C. (1996). Coerced treatment for substance abuse problems detected through workplace urine surveillance: is it effective?. Journal of Substance Abuse. 8(1), 115-128. Logan, T.K., Williams, K., Leukefeld, C., & Minton, L. (2000). A Drug Court Process Evaluation: ethodology and Fi ndings. Int. J. Offender Ther.Comp. Criminol, 44, 369 394. Longshore, D. & Prendergast, M.L. (1997). Drug Treatment Careers: A Conceptual Framework and Existing Research Findings. Journal of Substance Abuse Treatment. 14(6), 543-558. Lundy, A., Gottheil, E., Serota, R.D., Wein stein, S.P. and Sterling, R.C., 1995. Gender differences and similarities in African-A merican crack cocaine abusers. Journal of Nervous and Mental Disease 183, pp. 260. Magura, S. & Laudet, A. B., (1996). Parental su bstance abuse and child maltreatment: Review and implications for intervention. Childre n and Youth Services Review, 18(3), 192-220. Matano, R.N., & Yalom, I.D. (1991). Approach es to Chemical Dependency: Chemical dependency and interactive group therapy-A synthesis. Internati onal Journal of Group Psychotherapy, 41, 269-293. Marlatt, G. A., & Gordon, J. R. (Eds.). (1985) Relapse Prevention. New York: Guilford Press. 112

PAGE 113

Marsh J.& Miller, N., 1985. Fe male clients in substance abuse tr eatment. International Journal of Addictions 20, pp. 995. McLellan, D.C., Lewis, C.P., OBrien, & Kleb er, H.D. (2000). Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation, Journal of the American Medical Association 284 (13), pp. 1689. Miller. W. R., & Rollnick, S. (2002). Motivationa l Interviewing: Prepar ing people to change addictive behavior. (2nd ed.). New York: Guilford Press. Miller, W.R., & Kurtz, E. (1999). Models of al coholism used in treatment: Contrasting AA and other perspectives with which it is often confused. Journal of Consulting and Clinical Psychology, 67, 688-697. Moos, R.H. & Moos, B.S. (2007). Treated and Untreated Alcohol-Use Disorders. Evaluation Review. 31(6), 564-584. Myers, L.J. (1988). An Afrocentric world vi ew: Introduction to an optimal psychology. Dubuque, LA: Quintal-Hunt. National Association of Counties. (2005, July). The meth epidemic in America Retrieved October 7, 2007. Washington, DC: Author National Center on Addiction and Substance Abuse (1999). No Safe Haven: Children of Substance Abusing Parents. Authors: New York. Neighbors, H.W., & Jackson, J.S. (1996). Mental Health in Black America. Thousand Oaks, CA: Sage. Norcross, J.C. & Goldfried, M.R. (2005). Handbook of Psychotherapy Integration. Oxford University Press. OAS, SAMHSA, (2005). Results from the 2004 Na tional Survey of Drug Use and Health: National findings. Rockville, MD: Depa rtment of Health and Human Services. OSA, SAMHSA (2002). National and state estim ates of the drug abuse treatment gap: 2000 National Household Survey on Drug Abuse. Rockville, MD: SAMHSA. Pearce, M. (1999), National Center for State C ourts Information Service, "Drug Courts: A Criminal Justice Revolution", Report on Trends in the State Courts 1998-1999 Final Report (Williamsburg, VA: National Ce nter for State Courts, 1999), pp. 8-12. Peters, R.H., Haas, A.L., & Murrin, M.R.(1999). Predictors of Retention and Arrest in Drug Courts. National Drug Court Inst. Rev., 2, 33. 113

PAGE 114

Peters, R.H., Haas, A.L., & Murrin, M.R.(1998). Ev aluation of Treatm ent-Based Drug Courts in Floridas First Judicial Circuit. Research Update. National Drug Court Review. 2(1), 113114. Peyton, E. A., & Gossweiler, R. (2000, May). Ex ecutive summary: Treatment services in adult drug courts: Report of the 1999 National Drug Court Treatment Survey (NCJ 82293). Washington, DC: U.S. Department of Ju stice and the Center for Substance Abuse Treatment, Substance Abuse and Mental Hea lth Services Administration, Drug Courts Program Office, Office of Justice Programs. Phillips, F.B. (1990). NTU psychotherapy: An Africentric approach. Journal of Black Psychology. 17, 55-74. Prochaska, J. O., & DiClemente, C.C. (1992). Stages of Change in the modification of problem behaviors. Progress in Be havior Modification, 28, 183-218. Rapp, R.C., Siegal, H.A. Li, L. & Saha, P. ( 1998). Predicting Postprim ary Treatment Services and Drug Use Outcome: A Multivariate Analysis. American Journal of Drug & Alcohol Abuse., 24. Rempel, M. (2001). Predictors of engagement in court-mandated treatment: findings at the Brooklyn treatment court, 1996-2000. Drug Courts in Operation: Current Research. The Haworth Press. 87-124. Ricahrdson, T.M., & Williams, B.A. (1990). African -Americans in Treatment. Center City, MN: Hazelton Foundation. Roberts, C.A. (1999). Drug Use Among Inner-City African-American Wome n: The Process of Managing Loss. Qualitative Health Research, 9(5), 620-638. Rubenstein, G. (2003). Safe and sound: Models for collaborat ion between the child welfare & addiction treatment systems Retrieved October 7, 2007. New York: Legal Action Center of the Arthur Liman Policy Institute. Saum, C.A., Scarpitti, F.R., &Robbins, C. (2001). Violent Offenders in Drug Court. J. Drug Issues, 31, 107. Sechrest, D. K. & Shichor (2001). D. Determin ants of Graduation from a Day Treatment Drug Court in California: A Preliminary Study. J. Drug Issues, 31, 129. Schene, P.A. (1998). Past, present, and future roles of child protectiv e services. Future of Children. 8(1), 23-38. Schilling, R., Mares, A., & El-Bassel, N. (2004) Women in detoxification: Loss of guardianship of their children, Children & Y outh Services Review 26 (5), pp. 463. Schiff, M. &Terry, C. (1997).Predicting Graduation from Broward Countys Dedicated Drug Treatment Court. Justice System J., 19, 291. 114

PAGE 115

Scott-Lennox, J., Rose, R., Bohlig, A., & Lennox, R. (2000). The Im pact of Womens Family Status on Completion of Substance Abuse Treatment. Journal of Behavioral Health Services & & Research. Chapel Hill NC: Piedmont Research Institute. Sedlak, A.J. & Broadhurst, D.D. (1996). Third national incidence study of child abuse and neglect. NIS-3 (Washington, DC: DHHS, Ad ministration for Children and Families, Administration on Children, Youth and Fam ilies, National Center on Child Abuse and Neglect). Stark, M.J. (1992). Dropping out of substance abuse treatment. A clinically oriented review. Clinical Psychology Rev. 12, 93-116. Stephens, N. (1991). The Street addict role: A theory of hero in addiction. Albany, NY: State University of New York Press. Straussner, S.L.A. (Ed.).(1993). Cl inical work with substance-a busing clients. New York, NY: Guilford Press. Sue, D.W., & Sue, D. (1999). Counseling the Culturally Different: Theory and Practice. New York, NY: John Wiley & Sons, Inc.Sussman, L.K., Robins, L.N., & Earls, F. (1987). Treatment-seeking for depression by black and white Americans. Social Science and Medicine. 24(3). 187-196. Toni, Rebecca (2006). National Data Analysis System Issue Brief: Child Abuse & Neglect. Prepared by the Child Welfare League of America. Retrieved August 5, 2007, from http://ndas.cwla.org/include/PDF/C hildAbuseNeglect_F inal_IB.PDF Trone, J. & Young, D. (1996). Bridging Drug Treatm ent and Criminal Justice. New York: Vera Institute of Justice. Turner, S., Longshore, D.,Wenzel, S., Deschenes, E., Greenwood, P., Fain,T, Harrell,A., Morral, A., Taxman, E, Iguchi, M., Greene, J ., & McBride, D. (2002). A decade of drug treatment court research. Substance Use and Misuse, 37, 1489-1527. U.S. Department of Health and Human Servic es. (1999). Blending Perspectives and Building Common Ground: A Report to Congress on Substance Abuse and Child Protection. Washington, DC: U.S. Government Printing Office. U.S. Department of Justice. (2004). Family Dependency Treatment Courts: Addressing Child Abuse and Neglect Cases Using the Drug Court Model. Washington, DC: Office of Justice Programs. U.S. General Accounting Office (1997). Drug Courts : Overview of Growth, Characteristics, and Results. Washington, DC: U.S. General Accounting Office. 115

PAGE 116

116 Wald, R. (1992). Factors associated with treat ment attendance and treatment completion for substance-abusing women. Dissertation Abstracts International, 53 (10-B), 5144. Watson, A.L. & Sher, K.J. (1998). Resolution of alcohol problems without treatment: Methodological issues and fu ture directions of natural recovery research. Clinical Psychology: Science and Practice, 5, 1-18. Weisner, C., Greenfield, T., & Room, R. (1995). Tr ends in the treatment of alcohol problems in the U.S. general population 1979 thro ugh1990, Am J. Public Health. 85, 55-60. Westreich, L., Heitner, C., Cooper, M., Galanter, M. & Gued, J. P. (1997) Perceived social support and treatment retention on an inpatient ad diction treatment unit. The American Academy of Addiction Psychiatry, 6, 144. White, W & Kurtz, E. (2006). Linking Addiction Treatment and Communities of Recovery: A Primer for Addiction Counselors and Recove ry Coaches. Retrieved June 11, 2008, from www.friendsofrecoveryvt.org/articles/kurtzwhite.pdf Whitehead, R.L., Patterson, J., & Kaljee, L. (1994 ). The hustle: Socioeconom ic deprivation, urban drug trafficking, and low income, African-American male gender identity. Pediatrics. 93(6). 1050-1054. Wickizer, T., Maynard, M., Atherly, A., Frederic k, N., Koepsell, T., Krupski, A., & Start, K. (1994). Completion rates of clients discharg ed from drug and alcohol treatment programs in Washington state. American Journal of Public Health. 84, 215-221. Woodhouse, L.D. (1992). Women with jagged edges: Voices from a culture of substance abuse. Qualitative Health Research, 2(2), 262-281. Worcel, S.D., Green, B. L., Furrer, C.J., Bu rrus, S.W.M., Finigan, M.W. (2007). Family Treatment Drug Court Evaluation: Final Re port. Prepared by NPC Research. Retrieved July 27, 2007, from http://www.npcresearch.com/Files/ FTDC_Evaluation_Final_Report.pdf. Wright, R., Kail, B., & Crecy, R. (1990). Culturally sensitive social work practice with Black alcoholics and their families. In S. Logan, E. Freeman, & R. McCray (Eds.), Social work practice with black families (p. 203-222). White Plains, NY: Longman. Young, N.K., Gardner, S.L., & Dennis, K. ( 1998)., Responding to alcohol and other drug problems in child welfare: Weaving togeth er practice and policy., Child Welfare League of America Press, Washington, DC.

PAGE 117

BIOGR APHICAL SKETCH Rosa West was born in Weisbaden, Germany, a nd raised in Melbourne Florida. She was born of Walter and Alice West and is the youngest of three children. After graduating from Eau Gallie High School in 1997, Rosa attended the Univ ersity of Florida, majoring in psychology and sociology. She then went on to pursue her maste rs, specialist, and doctorate degrees in the Department of Counselor Education at the University of Florida. During that time she gained clinical experi ence working as a counselor in the community at a mental health and substance abuse facility for many years. There she had the opportunity to work with a family treatment drug court program and was inspired to e xplore ways of improving the structure of the program to a ssist parents in obtaining the services required to gain recovery and strengthen their families.