Veterans Treatment Courts

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Veterans Treatment Courts Studying Dissemination, Implementation, and Impact of Treatment-Oriented Criminal Courts
Baldwin, Julie M
Place of Publication:
[Gainesville, Fla.]
University of Florida
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1 online resource (409 p.)

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Doctorate ( Ph.D.)
Degree Grantor:
University of Florida
Degree Disciplines:
Criminology, Law, and Society
Sociology and Criminology & Law
Committee Chair:
Spillane, Joseph F
Committee Co-Chair:
Wilson, Jodi Lane
Committee Members:
Krohn, Marvin D
Gibson, Chris L
Travis, Patricia A
White, Michael
Graduation Date:


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Counties ( jstor )
Criminal justice ( jstor )
Criminal offenses ( jstor )
Funding ( jstor )
Mental health ( jstor )
Mentors ( jstor )
Post traumatic stress disorder ( jstor )
Substance abuse ( jstor )
Veterans ( jstor )
War ( jstor )
Sociology and Criminology & Law -- Dissertations, Academic -- UF
courts -- treatment -- veterans
City of Indian Rocks Beach ( local )
bibliography ( marcgt )
theses ( marcgt )
government publication (state, provincial, terriorial, dependent) ( marcgt )
born-digital ( sobekcm )
Electronic Thesis or Dissertation
Criminology, Law, and Society thesis, Ph.D.


The specialized court movement has been growing in recent decades, producing numerous specialized courts (e.g., drug, mental health, domestic violence, community, family, and gun courts) within the criminal justice system.Veterans Treatment Courts (VTCs) are the most recent innovation of the specialized court movement. The first VTC launched in January, 2008, in response to the large amount of veterans in contact with the criminal justice system. Experts, and this study, predict that this problem is growing, and will continue to do so, with the recent influx of new veterans returning to society.This dissertation is aimed at understanding and capturing VTCs and the national VTC movement at an early stage of development. It is comprised of two components: 1) national systematic examination of VTCs  2) in-depth exploration of a unique VTC. The general goal of component one was to understand the national landscape of VTCs at this critical moment. I formed a national compendium of VTCs, finding 114 operational VTCs. I created an online survey and administered it nationally using the compendium. The response rate was 69%of the population. Results(quantitative and qualitative) revealed both similarities and drastic differences among VTCs nationally. Additionally, I analyzed the national survey data using cluster analysis to discern whether a typology of VTCs exists, which yielded promising results. The second component’s general goals were to understand the structure, process, participants, and implementation issues of a specific VTC. I conducted an in-depth case study of the Palm Beach County Veterans Treatment Court (PBCVTC) in two phases: 1) exploratory case study 2)implementation case study. I collected data through a series of interviews of the VTC personnel and participants and observations of the VTC team meetings and court sessions. I created a detailed portrait of the structure, function,process, the team dynamics, and implementation of this unique specialized court.   Finally, I examined the PBCVTC within the national context, integrating the findings from both components (i.e., national survey and two-phase case study), which highlights the major findings of both studies. The dissertation culminates in a discussion of the importance of this research and suggested future research. ( en )
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In the series University of Florida Digital Collections.
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Includes vita.
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Thesis (Ph.D.)--University of Florida, 2013.
Adviser: Spillane, Joseph F.
Co-adviser: Wilson, Jodi Lane.
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by Julie M Baldwin.

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2 2013 Julie Marie Baldwin


3 Nations customarily measure the costs of war in dollars, lost production, or the number of soldiers killed or wounded. Rarely do military establishments attempt to measure the costs of war in terms of individual human suffering. Psychiatric breakdown remains one of the most costly items of war when expressed in human terms. Richard A. Gabriel No More Heroes: Madness and Psychiatry in W ar Wars and their effects are a continuing, permanent part of the personal and political landscapes that paradoxically demand incorporation and defy ready integration into an acceptable world vie w. The warriors image, his wounds, and the world he comes home to are a story that has been retold in Western culture at least from the time of Homer. The lessons of the Odyssey are the same as those of latetwentieth century social science wars may end, but they continue to reverberate in the lives of those who fought them and w ithin the soldiers societies. John Modell and Timothy Haggerty The social impact of war


4 ACKNOWLEDGMENTS I would like to thank my supportive and inspiring parents, Celia LaSala Baldwin and Donald Morrison Baldwin, Jr Their unwavering love, patience, support, and belief in me have made this accomplishment possible I could not ask for anything more in parents. I want to thank my brothers, David and Michael, for their humor and support. I want to thank Aunt Mary and Aunt Joanne and the Whitmarsh es for their continued help, advice, and belief in my talent and future I want to thank all of my aunts, uncles and cousins for their encouragement. I would li ke to thank Dr. Joseph F. Spillane, Dr. Marvin D. Krohn Dr. Michael D. White Dr. Chris L. Gibson Dr. Trysh Travis, and Dr. Jodi Lane for their invaluable guidance and advice. I want to thank Joe and Marv for their willingness to wor k with me over the last 4 years and Mike for his guidance over the last 10 years. Without Mike I would have never fallen in love with this field so many years ago. Without Joe, this dissertation would not have been possible. Wi thout Chris, I would not have the gotten the assista nt professor positio n I coveted. I look forward to working with, knowing and finding inspiration in them in the years to come. I tha nk John M. Eassey for his patience, support advice, and empathy throughout this process. His encouragement and reassurance made this process seem manageable at times when it felt impossible. He calmed me and kept me motivated in the most stressful and discouraging portions of this multi year endeavor. I thank my friends for their empathy, sympathy, suggestions, support and listening skills I thank my grad school friends, specifically, John Boman, Stephanie Ksionzyk Megan Kienzle, Saskia Santos, Molly Buchanan, and Joe Rukus. I want to thank Bryan Miller, the best grad mentor ever. They all have made this process,


5 although rigorous at times, an enjoyable experience overall. I know I have made lifelong friendships and look forward to our future collaborations and fun. I would like to thank all of my friends outside the University of Florida for the ir support and for being understanding of my 2 year absence, specifically, Natalie Loveland, Julie Fuller, Jason Epperhart, Tralona and Joe Boisne, Lauren Schneider, Angela Farford, and Janet Hicks. I also thank Julie Fuller, Thiag o De Araujo, and Myla for opening their home and making my data collecti on in South Florida possible. Finally, I want to sincerely thank all veterans for their service and sacrifice. I hope to contribute to the improvement of the services that they so desperately deserve. I specifically want to thank all of the veterans and t heir spouses in my family: Dado and Nana (Dr. Donald, Sr. and Rowena Baldwin), Nano and Grandma (Francis LaSala and Gertrude LaSala), Uncle Dick and Aunt Betsy (Richard and Betsy Wiedenbeck), Dad and Mom ( Donald, Jr. and Celia Baldwin), and my godfather St eve and his wife Kathy (Steve and Kathy Whitmarsh).


6 TABLE OF CONTENTS page ACKNOWLEDGMENTS .................................................................................................. 4 LIST OF TABLES ............................................................................................................ 9 LIST OF FIGURES ........................................................................................................ 13 LIST OF ABBREVIATIONS ........................................................................................... 15 ABSTRACT ................................................................................................................... 16 CHAPTER 1 INTRODUCTION .................................................................................................... 18 Problem and VTC Overview ................................................................................... 1 8 Goals and Research Questions .............................................................................. 23 Chapter Overview ................................................................................................... 25 2 SPECIALIZED COURTS, VETERANS ISSUES, AND THE VTC .......................... 27 Overview ................................................................................................................. 27 Specialized Courts .................................................................................................. 28 Drug Courts ...................................................................................................... 31 Drug court research ................................................................................... 35 Recommendations for future dr ug court research ...................................... 40 Mental Health Courts ........................................................................................ 40 Veterans Issues ..................................................................................................... 44 Veterans Psychological Issues ........................................................................ 45 Veterans Substance Use ................................................................................. 48 Veterans and Homelessness ............................................................................ 49 Veterans in the Incarcerated Population .......................................................... 50 Recommendations for Future Research ........................................................... 50 Veterans Treatment Courts (VTCs) ........................................................................ 51 Conclusion .............................................................................................................. 54 3 NATIONAL SURVEY OF VETERANS TREATMENT COURTS ............................. 56 Origins and Goals ................................................................................................... 56 Mixed Methodology and Multi Phase Research Design ......................................... 58 Population Frame: The National Compen dium ................................................. 58 Survey Design and Implementation .................................................................. 59 Analytic Plan: Quantitative and Qualitative Methods .............................................. 62 Response Rate ....................................................................................................... 66 Results and Discussion for the National VTC Compendium ................................... 69


7 Results and Discus sion for National Trends in VTCs ............................................. 71 VTC Respondents ............................................................................................ 71 Veteran Participants ......................................................................................... 72 VTC Elements .................................................................................................. 87 VTC Implementation Issues ........................................................................... 101 Perceptions of Participants ............................................................................. 106 Perceptions of VTCs ...................................................................................... 111 National Survey Limitations .................................................................................. 114 National Survey Conclusion .................................................................................. 116 VTC Typology ....................................................................................................... 121 Typology Variables ......................................................................................... 121 Staffing, structure, and resources ............................................................ 121 Role of treatment providers: therapeutic centered versus management centered ................................................................................................ 123 Eligibility requirements: creamers versus al l purpose .............................. 126 Typology Results and Discussion ................................................................... 127 Typology Limitations and Conclusion ............................................................. 132 4 CASE STUDY OF THE PALM BEACH COUNTY VETERANS TREATMENT COURT (PBCVTC) ............................................................................................... 134 Case Study Overview ........................................................................................... 134 Ca se Study One: Exploratory ............................................................................... 135 Research Design ............................................................................................ 135 Exploratory Results ........................................................................................ 136 Conclusion ...................................................................................................... 144 Case Study Two: Implementation ......................................................................... 145 Research Design and Data Collection ............................................................ 145 Team meeting structured observations .................................................... 146 Open court structured observations ......................................................... 148 Initial inte rviews ........................................................................................ 150 Data Management .......................................................................................... 155 The Samples .................................................................................................. 158 The interview sam ple ............................................................................... 158 The structured observation sample (sampling frame) .............................. 161 The team meeting and court session samples ......................................... 161 Results and Discussion .................................................................................. 162 Screening process and reaching the target population ............................ 162 Early identification and case transfer ....................................................... 166 Early evaluation ....................................................................................... 169 Quickly linking veterans to services based upon evaluation res ults ......... 171 Ongoing interaction between judge and participants ............................... 174 Ongoing interaction between veterans and mentors ................................ 175 Organization and agency partnerships .................................................... 176 VTC team working in nonadversarial manner ......................................... 179 Case Study Two Conclusion .......................................................................... 184


8 5 INTEGRATIVE FINDINGS AND FUTURE RESEARCH ....................................... 187 Overview ............................................................................................................... 187 Mission and Goals ................................................................................................ 187 Conceptualization ................................................................................................. 188 Implementation ..................................................................................................... 191 Graduated System of Rewards and Sanctions ............................................... 193 Early Identification and Evaluation ................................................................. 193 Ment oring ....................................................................................................... 194 Conflict and Collaboration .............................................................................. 194 Additional Challenges for a Rapidly Diffusing Institution ....................................... 196 Changing Populations .................................................................................... 196 Era of service and age ............................................................................. 196 Increase in female veterans ..................................................................... 197 Delayed onset .......................................................................................... 198 Funding for Services ...................................................................................... 199 VTC Research: The Next Steps ............................................................................ 199 Multi Site Comparisons .................................................................................. 200 Intermediate Outcomes .................................................................................. 201 Mech anisms for Diffusion ............................................................................... 204 Theoretical Framework ................................................................................... 205 Conclusion ............................................................................................................ 208 APPENDIX A TABLES ................................................................................................................ 211 B FIGURES .............................................................................................................. 278 C NATIONAL SURVEY OF VETERANS .................................................................. 302 D APPROVALS AND PROTOCOL .......................................................................... 323 E SUPPLEMENTAL DOCUMENTS ......................................................................... 358 LIST OF REFERENCES ............................................................................................. 387 BIOGRAPHICAL SKETCH .......................................................................................... 409


9 LIST OF TABLES Table page A 1 BJS Special Report on Veterans in State and Federal Prison, 2004 ................ 211 A 2 Percentage of Veterans in State Prison by Service Era ................................... 212 A 3 National Compendium & Survey Timeline ........................................................ 213 A 4 List of Veterans Treatment Courts in the United States as of November 2012 214 A 5 Location of Veterans Treatment Courts by Region and St at e .......................... 219 A 6 Frequency Trends of VTCs in Operation within the 32 States with VTCs ......... 220 A 7 Respondent Characteris tics .............................................................................. 220 A 8 Status of Veterans in 79 VTCs ......................................................................... 221 A 9 Reasons for Opt out and Drop out .................................................................... 222 A 10 Reasons for Termination .................................................................................. 223 A 11 Demographics of Veterans that Have Ever Participated in 79 VTCs ................ 224 A 12 Issues Facing Veteran Participants by Sex ...................................................... 225 A 13 Veteran Criminal Offenses by Sex .................................................................... 225 A 14 Mission Components ........................................................................................ 226 A 15 VTC Objectives ................................................................................................. 227 A 16 VTC Target Populations ................................................................................... 228 A 1 7 General VTC Characteristics ............................................................................ 229 A 18 Treatments and Services Available by Provider Type ...................................... 230 A 19 Stage of Veteran Identifica tion .......................................................................... 230 A 20 Eligibility Exclusions ......................................................................................... 231 A 21 Eligibility Screeners .......................................................................................... 233 A 22 Initial Evaluation Information ............................................................................. 234 A 23 Participation Requirements .............................................................................. 235


10 A 24 Means of Supervision ....................................................................................... 235 A 25 Mentor Assignment ........................................................................................... 236 A 26 Frequency of VTC Sessions and Meetings ...................................................... 236 A 27 Frequency of VTC Member Presence during VTC Sessions ............................ 237 A 28 Legal and Financial Benefits of Participation/Graduation ................................. 238 A 29 Graduation Requirements ................................................................................ 239 A 30 Mentoring Issues .............................................................................................. 239 A 31 Perceptions of Participant Change ................................................................... 240 A 32 Most Effective Components of VTC .................................................................. 241 A 33 Ineffective VTC Components ............................................................................ 242 A 34 Challenges Facing VTCs .................................................................................. 243 A 35 Suggested Changes ......................................................................................... 244 A 36 Structure and Staff Model (Model 1a) ............................................................... 245 A 37 Structure and Staff Model (Model 1b) ............................................................... 246 A 38 Treatment Provider Orientation Model (Model 2) .............................................. 247 A 39 Eligibility Model (Model 3) ................................................................................. 247 A 40 Full Model (Model 4a) ....................................................................................... 248 A 41 Full Model without Maximum Jurisdiction (Model 4b) ....................................... 249 A 42 List of Veterans Treatment Courts by Region and State .................................. 250 A 43 Non response Rates by Region ........................................................................ 251 A 44 Non response Rates by Two Regions .............................................................. 251 A 45 Case Study Timeline ........................................................................................ 251 A 46 PBCVTC Team Members Definitions of Success ............................................ 252 A 47 Process and Impact Goals ................................................................................ 253 A 48 PBCVTC Case Study Structured Observation Instruments .............................. 256


11 A 49 P BCVTC Case Study Initial Interview Instruments ........................................... 257 A 50 Outcome R ate C ategories ................................................................................ 258 A 51 Rate E stimates ................................................................................................. 258 A 52 Reasons for Ineligibility ..................................................................................... 258 A 53 Participating and Nonparticipating Eligible Veterans by Group ........................ 259 A 54 Reasons for Nonparticipation by Group ............................................................ 259 A 55 Outcome R ate C ategories ................................................................................ 260 A 56 Rate E stimates ................................................................................................. 260 A 57 Interview Samples Demographics ................................................................... 261 A 58 Interview Samples Military Characteristics ...................................................... 263 A 59 Sampling Frames Current Drug Offense Counts and Types ........................... 264 A 60 Sampling Frames Current Violent Offense Counts and Types ........................ 264 A 61 Sampling Frames Current Weapon Offense Counts and T ypes ...................... 265 A 63 Sampling Frames Current Traffic Offense Counts and Types ......................... 266 A 64 Sampling Frames Current Other Offense Counts and Types .......................... 267 A 65 Sampling Frames VA Eligibility Information ..................................................... 267 A 67 Learning of and Transferring Cases to PBCVTC (Int erview Sample) ............... 269 A 68 VJO Evaluation Directive and Compliance ....................................................... 270 A 69 Linking Veterans to Services ............................................................................ 270 A 70 Percentage of Diagnosed Veterans Connected to Services ............................. 271 A 71 Veteran Satisfaction with VJO Linkage to Services .......................................... 271 A 72 Frequency of Court Appearance by Group ....................................................... 271 A 73 Frequency of Participant and Current Mentor Communication by Method ....... 272 A 74 Frequency of Participant and Previous Mentor Communication by Method ..... 272 A 75 Process Goals .................................................................................................. 273


12 A 76 Treatment Attendance for Veterans Appearing for First Status Check Occurring in Wave I .......................................................................................... 274 A 77 Confrontation Levels of Team Members in Team Meetings ............................. 274 A 78 Levels of Reservation of Team Members in Team Meetings ............................ 275 A 79 Team Member Involvement in Team Meetings ................................................. 275 A 80 Confrontation Levels Between Team Members in Court Sessions ................... 276 A 81 Confrontation Levels Between Team Members and Veterans in Court Ses sions ........................................................................................................... 277


13 LIST OF FIGURES Figure page B 1 A Model of the Consequences of Post Deployment Mental Health and Cognitive Conditions ....................................................................................... 278 B 2 National Survey Multi Phase Research Design ................................................ 279 B 3 United States Census Regions (U.S. Census Bureau) ..................................... 280 B 4 Map of Veterans Treatment Courts in Operation in the United States .............. 281 B 5 Number of VTCs Established by Year .............................................................. 282 B 6 Supervising Agents Policy v. Practice .............................................................. 283 B 7 Evaluation of VTC Team Members ................................................................... 284 B 8 Evaluation of Agencies Working with VTC ....................................................... 285 B 9 Respondent Belief in Relationship between Military Experience and Personal Issues ............................................................................................................... 286 B 10 Respondent Belief in Relationship between Personal Issues and Criminal Justice Contact ................................................................................................. 286 B 11 Respondent Belief in Relationship Military Exper ience, Personal Issues, and Criminal Justice Contact ................................................................................... 287 B 12 Program Requirement Difficulty Level by Sex .................................................. 288 B 13 R espondent Perceptions of Veteran Participants ............................................. 289 B 14 Perceptions of Importance of Mentor Characteristics ....................................... 290 B 15 Perceptions of Effectiveness ............................................................................ 291 B 16 Perceptions of Impact and Goal Achievement .................................................. 292 B 17 Veterans Status by Sex, R ace, and Hispanic Origin 2009 ................................ 293 B 18 Veteran Living by Period of Service, Age, and Sex 2010 ................................. 294 B 19 Military Service Experiences of Responding Veterans ..................................... 295 B 20 Dendogram for Treatment Provider Orientation ............................................... 296 B 21 Single Case Embedded Design........................................................................ 297


14 B 22 PBCVTC Logic Model ....................................................................................... 298 B 23 PBCVTC Service Utilization Plan ..................................................................... 299 B 24 Drug Court Locations in the United States and Tribal Lands ............................ 301 C 1 National Survey ................................................................................................ 302 D 1 National Survey I RB Protocol ........................................................................... 323 D 2 IRB Exemption Letter for National Survey ........................................................ 326 D 3 VJO Access Letter ............................................................................................ 327 D 4 15th Judicial Circuit Court Administration Access Letter .................................. 328 D 5 Team Meeting Observation IRB Protocol ......................................................... 329 D 6 Team Meeting Observation IRB Exemption ..................................................... 332 D 7 Open Court Observation IRB Protocol .............................................................. 333 D 8 VTC Open Court Observat ion IRB Exemption .................................................. 336 D 9 I nitial Interview IRB Protocol ............................................................................. 337 D 10 Initial Interview IRB Approval ............................................................................ 346 D 11 Follow up Interview IRB Protocol ...................................................................... 349 D 12 Follow up Interview IRB Approval ..................................................................... 355 E 1 VA Service Determination ................................................................................ 358 E 2 House Bill 5214 ................................................................................................ 359 E 3 VJO Contact Form ............................................................................................ 360 E 4 VJO Entry Form ................................................................................................ 368 E 5 Homelessness Assessment .............................................................................. 372 E 6 Department of Veterans Affairs Medical Release ............................................. 384 E 7 Administrative Order for the PBCVTC .............................................................. 385


15 LIST OF ABBREVIATIONS DOC Department of Corrections OEF Operation Enduring Freedom (Afghanistan) OIF Operation Iraqi Fr eedom (Iraq) OND Operation New Dawn PTSD Post Traumatic Stress Disorder TBI Traumatic Brain Injury VA United States Department of Veterans Affairs VBA Veterans Benefit Administration VJO Veterans Justice Outreach Specialist through the Veterans Health Adm inistration VSO Veterans Service Officer through the American Legion VTC Veterans Treatment Court


16 Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy VETERANS TREATMENT COURTS: STUDYING DISSEMINATION, IMPLEMENTATION, AND IMPACT OF TREATMENT ORIENTED CRIMINAL COURTS By Julie Marie Baldwin May 2013 Chair: Joseph F. Spillane Major: Criminology, Law, and Society The speci alized court movement has been growing in recent decades, producing numerous specialized courts (e.g., drug, mental health, domestic violence, community, family, and gun courts ) within the criminal justice system Veterans Treatment Courts (VTCs) are the m ost recent innovation of the specialized court movement. Th e first VTC launched in January, 2008, in response to the large amount of veterans in contact with the criminal justice system. Experts, and this study, predict that this problem is growing, and wi ll continue to do so, with the recent influx of new veterans returning to society. This dissertation is aimed at understanding and capturing VTCs and the national VTC movement at an early stage of development It is comprised of two components: 1) national systematic examination of VTCs 2) indepth exploration of a unique VTC The general goal of component one was to understand the national landscape of VTCs at this critical moment I formed a national compendium of VTCs, finding 114 operational VTCs I c reated an online survey and administered it nationally using the compendium. The response rate was 69% of the population Results (quantitative and qualitative) revealed both similarities and drastic differences among VTCs nationally


17 Additionally, I analy zed the national survey data using cluster analysis to discern whether a typology of VTCs exists which yielded promising results. The second components general goals were to understand the structure, process, participants, and implementation issues of a specific VTC. I conducted an in depth case study of the Palm Beach County Veterans Treatment Court (PBCVTC) in two phases: 1) exploratory case study 2) implementation case study. I collected data through a series of interviews of the VTC personnel and par ticipants and observations of the VTC team meetings and court sessions. I created a detailed portrait of the structure, function, process, the team dynamics, and implementation of this unique specialized court. Finally, I examined the PBC VTC within the n ational context, integrating the findings from both components (i.e., national survey and two phase case study), which highlights the major findings of both studies. The dissertation culminates in a discussion of the importance of this research and suggest ed future research.


18 CHAPTER 1 INTRODUCTION Problem and VTC Overview The contemporary mental health and public health frameworks within which the state delivers public services for veterans are products of the Vietnam era. While the consequences of warti me experiences were the subject of some scholarly inquiry prior to Vietnam, post Vietnam research accounts for the vast majority of what is today known about veterans issues. Over time, research on the impact of wartime service has expanded from a limit ed focus on physical impacts to incorporate mental health, substance use, and behavioral issues and, increasingly, these impacts are understood to affect combat and noncombat veterans alike. Research has also observed a higher prevalence of mental health problems (e.g., PTSD and substance abuse behavior) related to illegal and violent behavior in the veteran population than the nonveteran population (Greenberg and Rosenheck, 2009). For example, the Bureau of Justice Statistics (BJS) reported that state in carcerated veterans were more likely to have a recent mental health history (e.g., overnight hospital stay, being proscribed medication, and receiving services from mental health professionals) than nonveterans (Noonan and Mumola, 2007). In sum, post Vietn am research has made the case that a distinct constellation of issues and needs results from the experience of military service, training, or the status of being a veteran. With more than 1.9 million U.S. military personnel having been deployed to Iraq and Afghanistan in 3 million duty tours of more than 30 days in Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND) (Institute of Medicine, 2010), responding to wars impact on those who serve has gained a


19 renewed salience. Because survival rates from current wars are higher than previous engagements (Peake, 2005), more veterans are surviving physical trauma and returning with mental health issues (e.g., TBI, PTSD, and depression) in addition to chronic pain and physi cal conditions; they join the already existing veteran population with issues (Baker et al., 2009; Grieger et al., 2006; Hoge et al., 2004; Hoge et al., 2008; Milliken, Auchterlonie, and Hoge, 2007; Seal et al., 2007; Seal et al., 2009; Tanielian and Jayc ox, 2008; Veterans for America, 2007). Further, even as physical injuries and fatalities are fewer in current wars as compared to previous, the current essence of recent combat endeavors has increased mental stress (Bongar et al., 2007). Specifically, r epeated and extended deployment has been related to physical and mental health issues (Hoge et al., 2004), and this is characteristic of OIF and OEF where 75% of these troops have been deployed at least two times. OIF and OEF constitute the longest sustained military operation by the U.S. since the Vietnam War. Approximately 17% of OIF returners were diagnosed with a serious mental disorder, which is a twofold increase over the predeployment levels (Hoge et al., 2004). The National Defense Council (2009) found that 25% to 40% of current returning veterans have psychological and neurological injuries related to PTSD or TBI and has called these the signature injuries of the Iraq War. The current military care system has been labeled inadequate in meeting the present mental health needs of veterans and their families. Obstacles to receiving mental health treatment have been identified as insurance coverage issues and the stigma (real or perceived) related to receiving mental health treatment (DOD Task Force on Mental Health, 2007). Only 23% to 40 % of those with PTSD sought mental health


20 care, and those with these problems tend to have a higher concern about stigmatization and other issues regarding mental health care (Hoge et al., 2004). Military resistance to m ental health care emanates from anticipated negative perceptions by peers and leaders and is disproportionately greatest among those most in need of those mental health services (Hoge et al., 2004). Further, a requirement for VA eligibility is a discharge status other than dishonorable (U.S. Department of Veterans Affairs, 2010), which excludes veterans who have served and are in need of services but have been dishonorably discharged ( Figure E 1 displays the list of requirements for VA Service Determination). With prison overcrowding a continued problem in the contemporary criminal justice system, it is important to note that incarcerated veterans are reported to have longer prison sentences than nonveterans. The average maximum sentence for a veteran in st ate prison is 147 months, which is 2 years longer than the maximum sentence for nonveterans (119 months). Veterans serve an average 22 months longer than nonveterans (112 months versus 90 months). This is occurring despite the fact that veterans have short er criminal histories than nonveterans incarcerated in state prison (Noonan and Mumola, 2007). Regarding crime type, 57% of veterans incarcerated in state prison and 19% of veterans in federal prison in 2004 were sentenced for violent offenses. Forty seven percent of nonveterans in state prisons and 14% of nonveterans in federal prisons were serving time for violent offenses. In federal prison, 46% of veterans were serving time for drug offenses. However, the longer sentences for veterans are not solely caused by their violent offense rates. Veteran sentences


21 average longer than nonveteran sentences regardless of the type of offense (Table A 1). Of all the publicly funded responses to the intertwined problems of crime, mental illness, trauma, and substance abuse among veterans, the most recent and certainly the most notable program development has been the rapid rise and diffusion of the veterans court, also known as the veterans treatment court (VTC). VTCs are another form of specialized court in the public court system; they are not military courts (courts martial).1 VTCs aim to divert veterans in the criminal justice system to nontraditional channels of justice and provide veterans with appropriate treatment. For example, if a VTC operates in a jurisdiction, an eligible veteran would be transferred from the traditional court docket to the VTC docket and then required to receive treatment and complete the VTC program in lieu of sanctions prescribed by the traditional court, such as incarceration. The VTC re presents a critical policy innovation built on two conceptual foundations. The first is the massive research base indicating that the veteran population has a higher prevalence of specific issues (e.g., mental health, PTSD, reintegration, substance abuse) that: 1) may put veterans at a higher risk for incarceration than the general population (e.g., Boivin,1987; Greenberg and Rosenheck, 2009; McGuire, Rosenheck, and Kasprow, 2003; Saxon et al., 2001; Shaw 1 Courts martial are military courts within the U.S. military system, which enforce military law, the Uniform Code of Military Justice (UCMJ). Generally, UCMJ has jurisdiction over all U.S uniformed services and delineates both high crimes and misdemeanors of officials and military personnel. In comparison to the civilian legal system, the UCMJ criminalizes behaviors that civilians understand as ordinary crimes, as well as various behavior s that civilians consider legal behavior. Further, the UCMJ mandates different standards of proof and punishments as compared to the civilian court system. This differentiation exists on the belief that their military oaths of office require higher standar ds of behavior and responsibility than the public.


22 et al., 1984) 2) have been shown to be related to il legal, violent, and/or hostile behavior (Elbogen, 2011; Elbogen et al., 2010; Greenberg and Rosenheck, 2009). Again, many hold that a distinct constellation of issues and needs results from military service and/or training in subsequent years. Much of this previous research on veterans has utilized the lifecourse perspective. The second foundation for developing VTCs is the ongoing spe cialized court movement and related research which are predicated on the notion that specialized groups demand particular sets of services/responses and that specialized courts are a vehicle for connecting people to those services. For veterans, the need for particular responses has been discussed and obstacles have been identified to receiving certain services, such as probl ems obtaining insurance coverage and the stigma (real or perceived) related to receiving mental health treatment (DOD Task Force on Mental Health, 2007). Currently, little is known about VTCs in general, let alone anything regarding their impact; however, they have quickly spread across the country and are functioning on municipal, state, and federal levels with funding from all levels of government, as well as from public and private donations. This dissertation aims to examine both the issues present wit hin the veteran population currently in contact with the criminal justice system and the role and function of the specialized court. This course of research is being conducted at a critical point in time. Not only will there be an influx of returning veter ans from OEF, OIF, and OND in the near future, but we are only currently aware the problems facing veterans from research to date. In a twophase study commissioned by Congress, the Institute of Medicine found that veteran requests from previous wars for disability and compensation peaked more than 30 years after service


23 ended (IOM, 2010). The IOM reported that the issues of OIF and OEF veterans and families may not be reaching the maximum point until 2040 or later. It is important to determine the issues o f veterans in contact w ith the criminal justice system as well as what these innovative courts are doing, how they are doing it, and whether and how their operation and implementation impact veterans. Goals and Research Questions The purpose of this dissertation is to break ground in a new area of veterans and specialized court research, VTCs. With the first VTC only established in January of 2008, no research on VTCs has been published to date. VTC literature currently consists of one overview of VTCs (Cartwright, 2011), media coverage, an informational article written by the founding judge (Russell, 2009), and several mentions in literature on related areas such as veterans issues and veterans in the incarceration population (e.g., Erickson, 2008; White 2 010; White, Mulvey, Fox, and Choate, 2011). This dissertation is exploratory in nature and s trives to discern the information in the following areas. 1. How many VTCs exist nationwide? a) In operation b) In process of being established 2. Who are these veterans in VTC s nationally? a) Demographics b) Military history c) Offenses d) Issues they face 3. Are there trends in VTCs nationally?


24 a) Are there trends in VTC establishment, funding, goals, and procedure? b) Do trends in program structure exist? i) Participation requirements ii) Involvement of agencies and individuals and the roles they are proscribed iii) Program process and operation iv) Treatments available 4. Do implementation issues exist within VTCs? If so, what are they and how are they evident? a) Is there dis agreement in goals and belief in relationships between military service and offending between members of the court and treatment providers, between treatment providers, between agencies, and within agencies? b) Is there discrepancy between eligibility, screening, and admittance? c) Is there a deviation from policy and proscribed procedure? 5. What are the personnels perceptions of participants and of the VTCs? a) Personnel perceptions of participants i) Struggles of the participants most difficult parts of program ii) Easiest components for participants to compl ete iii) Perceptions of impact iv) Relationships between charges, military experience, and issues v) Attitudes b) Personnel perceptions of VTCs i) Challenges facing VTCs ii) What they would change 6. Does a typology of VTCs exist? If so, what categories are evident and what are th e defining characteristics?


25 Chapter Overview My dissertation consists of two main components: a national level exploration of the VTC movement and a detailed examination of a single VTC within this national context. Specifically, this project discerns tren ds in the creation, dissemination, and implementation of VTC across the nation and identifies the structure, goals, process, and implementation issues of the Palm Beach County Veterans Treatment Court (PBCVTC). This dissertation consists of five chapters. Chapter 2 presents a review of the literature on the two pillars of the VTC movement the operation and function of specialized courts and the issues facing veterans. The review of specialized courts places a particular focus upon the closest operational c ousins of the VTCs, drug courts and mental health courts. For reviews of the literature on the issues facing veterans, I survey mental health, substance abuse, homelessness, and incarceration literature. The chapter concludes with an explanation of the VTC and discussion of the two published overviews available to date. Chapter 3 presents the national survey of VTCs. I introduce t he origins and goals of the study and review the research design and analytic plan. Then, I present and discuss the results of t he national survey in the National Survey Results section, beginning with the compendium results and moving onto the trend results, including respondent information and trends in the VTC participants, VTC element, implementation issues, and perceptions of both the participants and the VTCs themselves. The VTC typology variables are described, and the typology results are then presented and discus sed (VTC Typology Variables and Typology Results and Discussion sections, respectively). In the Limitations secti on, I address the limitations of both the national survey and the typology, such as issues in analysis and interpretation.


26 I conclude the chapter with the importance of this research and suggestions for future research endeavors. Chapter 4 describes t he se cond original study, the case study of the PBCVTC. After a broad overview, I present the two phases in their own s ections: exploratory case study and implementation case study For the exploratory case study, I explain the research design and present the d escriptive results of the PBC VTC program including the presentation of a logic model, service utilization plan, and a process and impact goal and measure table. Additionally, Chapter 4 contains the research designs, data collection and management procedur es, results and discussions the implementation case study Conclusion sections for each study close the respective sections Chapter 5 integrates the findings of the PBCVTC case study with the findings of the national survey, examining the case study withi n the national context of VTCs. The chapter culminates in a conclusion of these results and the importance of this research, followed by a discussion of directions for future research.


27 CHAPTER 2 SPECIALIZED COURTS, VETERANS ISSUES, AND THE VTC Overview Drug courts, mental health courts, domestic violence courts, community courts, family courts, and gun courts are some of the specialized courts that have emerged over the previous few decades. VTCs are the most recent spawn of the specialized court movement and have emerged due to the perception of veterans experiencing a specific set of problems that may lead to contact with the criminal justice system. Although no research on VTCs currently exists, research examines other specialized courts, particularly drug courts, in considerable detail. In addition, an enormous literature examines mental health and substance abuse problems within the veteran population (e.g., Baker et al., 2009; Bjork and Grant, 2009; Bremner et al., 1996; Brunello et al., 2001; Calhou n et al., 2008; Corrigan and Cole, 2008; Drug Policy Alliance, 2009; Eggleston, Straits Troster, and Kudler, 2009; Graham and Cardon, 2008; Grieger et al., 2006; Hoge et al., 2004; Hoge et al., 2008; Jacobson et al., 2008; Jorge et al., 2005; McFall and Cook, 2006; Milliken, Auchterlonie, and Hoge, 2007; Ponsford, WhelanGoodinson, and Bahar Fuchs, 2007; Seal et al., 2007; Seal et al., 2009; Stahre et al., 2009; Tanielian and Jaycox, 2008; Veterans for America, 2007). Because the VTC is a specialized court and VTCs strive to address the issues of veterans, the literature on specialized courts and veterans issues are reviewed in this chapter.


28 Specialized Courts Specialized courts are created and designed to address specific theorized causes of or behaviors associated with criminal activity1. They emerged throughout the latter part of the 20th century in response to the understanding of the relationship between certain individual and/or social factors and crime. Support for specialized courts exists across pol itical party lines because they provide both treatment and sanctions with the goal of eliminating/reducing recidivism. Berman and Feinblatt (2001) provided the following five elements of specialized court programs: 1. Concerned with outcomes: recidivism, trea tment completion, and/ or crime reductions in the community 2. A level of system change: including treatment and rehabilitation goals 3. Enhanced judicial monitoring: one judge throughout the course of the process 4. Collaboration: judges, attorneys, and community 5. N ontraditional roles of the legal advocates Each specialized court is different with regard to the problem(s) addressed, goals, jurisdiction, local issues (e.g., politics, funding, treatment availability, and localized drug, economic, and community issues) and court and program structure. The specialized court movement flourished in an era (1980s and 1990s) where get tough policies and the philosophy of retribution were in full swing2. With criminal 1 Juvenile courts have been excluded from this review of specialized courts. Juvenile courts are located within the juvenile justice system, and traditional juvenile courts are not normally considered spec ialized courts. Juvenile courts handle offenders based on offender age and not social or behavioral issues that have been correlated to crime. Mack (1909) provides an early account of juvenile courts. An effort to create intermediate specialized courts for older adolescents gained some support at midcentury but, in general, the elements of these specialized courts remained confined to the juvenile justice system. 2 Prior to the 1970s, rehabilitation was a major goal within the criminal justice system although it was never implemented correctly. With the publication and popularization of Martinsons (1974) What works? questions and answers about prison reform, most abandoned the model and goals of rehabilitation and shifted focus to incapacitation, deterrence, and retribution.


29 justice costs reaching astonishing levels and caseloads overwhelming prisons and court dockets, criminal justice officials began searching for a new course of action that would respond to public demands for crime control, yet promote the cost and timeefficient handling of cases. Berman and Feinblatt (2001) noted that the emergence of specialized courts has corresponded with several justice administration imperatives such as addressing failed responses to growing social problems, a focus on public accountability, and the increase in the incarceration rate. Specialized courts have also been considered a consequence of the movement toward community justice, where community and court partner in the shared interest of restorative justice (Further, Fagan, and Malkin, 2003). Specialized courts have issues distinct o f those existing in the traditional court system. An issue prevalent within specialized courts is the coexistence of competing logics. Baldwin and Spillane (Forthcoming) discuss the relationship between bureaucratic efficiency and therapeutic optimism in drug courts. Specialized courts emerged from a need to make the criminal justice system more efficient and the desire to address the underlying causes of criminality. It is believed that if the root causes of crime are addressed then the offender will be rehabilitated and eliminate future contact with the system, which would decrease court caseloads and the incarcerated population and result in a more efficient system. Mirchandani (2005) held that there may be a conflict of interest between addressing social problems while decreasing costs and traced the tension between social control and social change in domestic violence courts.


30 Not all scholars feel that the specialized court model is an improvement on either the traditional court system or external soci etal attempts that address social problems. Some argue that the role of legal actors is compromised in the specialized court and that traditional justice is less a priority than efficiency (Davis 2003; Lane 2003). Specialized courts have a tendency to prol iferate quickly3 without any preliminary program evaluation, development of an overreaching model, or consensus on issues and theory (Baldwin and Spillane, Forthcoming). Due to this lack of agreement on problems and methods, McCoy (2003) suggested that it may be more appropriate for traditional courts to address local, decentralized and particularized problematic issues than having these specialized courts (p. 1516). Although VTCs are the focus of this dissertation, a comprehensive review of the litera ture on drug courts and mental health courts is included here for two reasons. First, the VTC is the direct genealogical descendent of drug courts and mental health courts; todays first generation VTCs are explicitly drawing upon these specialized courts as models. Judge Robert T. Russell based the first VTC on the 10 key components of drug courts (listed later) and the 10 key components of mental health courts (Russell, 2009), which are based upon the 10 key components of drug courts. Illinois Veterans and Servicemembers Court Treatment Act specifically provides a definition for its VTCs that includes the statement that Veterans Affairs professionals, local social programs, and intense judicial monitoring will occur in accordance with the 3 The first domestic violence court was established in 1996 in Brooklyn, and by 2000, 200 were in operation nationally (Nolan, 2003). The first drug court emerged in Miami in 1989, and by 2002, 800 were in operation (Goldkamp, 2003). 1,212 drug courts were in operation in the 50 states, District of Columbia, Guam, Puerto Rico, and two federal districts by September of 2004, and more than 400,000 offenders have participated in drug court programs according to Wiseman (2005). By 200 4s end, 1,600 drug courts were in operation, and 215 more were being developed (VanderWaal et al., 2006).


31 nationally recommended 10 key components of drug courts (HB 5214 Section 10)4. Second, much of the direct training of VTC personnel has been directed by drug court agencies. The National Drug Court Institute (NDCI) with the Bureau of Justice Assistance (BJA) held the 2010 Veterans Treatment Court Planning Initiative (VTCPI), and the National Association of Drug Court Professionals (NADCP) had more than 10 hours dedicated to veterans issues at their 16th annual training conference5. Since then, the NADCP has and continues to sponsor various training initiatives. Much of the press and discussion regarding VTCs have either compared them to or simultaneously discussed drug courts. The similarities between drug courts and VTCs are addressed in a later section. Drug Courts Th e primary reasons for the creation of drug courts have been identified as the massive increase in caseloads, corresponding court backlogs, and institutional overcrowding. Although it has experienced some recent decline in particular areas ( Carson and Sabol 2011), s ince 1980, the prison population has grown almost 300% (Caplow and Simon, 1999) with 2,320,359 individuals being incarcerated in jails and prisons by the end of 2005 (Harrison and Beck 2007)6. The Supreme Court of Florida offered Judge Herbert M Klein, the chief judge of Floridas 11th judicial court, a oneyear leave of absence to research inmate populations in an effort to discover a way to 4 See Figure E 2 for the HB 5214 legislation. 5 T hese training modules can be downloaded at NADCPAnnualConference. 6 Additional factors specific to Florida and Miami were proximity to drug importing regions of Latin America, making Miami a major hub for drug trafficking, and violations of the States speedy trial rule due to system overload (Harrison & Scarpitti, 2002).


32 comply with federal mandates for inmate population reduction (Wiseman, 2005). Judge Klein observed that most inmates had been incarcerated for drug offenses and that the majority were rearrested because of their drug addictions (Wiseman, 2005). In addition to addressing the immediate and pressing issue of overwhelming caseloads, the resolution needed to not overburden the system down the line; the original aim was bureaucratic justice. In 1989, Dade County, Florida created the first drug court in the wake of the pressure within the legal and correctional systems, the large recidivism rates of drug offenders discovered by Judge Kleins research, and Judge Kleins concept of a court that would be based in treatment and handle drug cases7. Drug courts differed from traditional courts in numerous ways. The Miami team realized that early intervention was an important factor and drug treatment needed to begin immediately after arrest (Harrison and Scarpitti, 2002). The Miami drug court sought to reduce recidivism related to drug offenses by sentencing offenders to long term drug treatment and supervision in lieu of incarceration in an effort to avoid later contact with the system and future caseload increases, as well as decrease the enormous incarcerated population. Drug courts emphasized substance abuse treatment, case management, nontraditional judicial interac tion with intense participant monitoring through drug and alcohol tests8, a system of graduated rewards and 7 For a thorough historical analysis of the century long emergence of drug courts and the pressures leading up to the creation of Miamis drug court in 1989, see Spillane and Baldwins Drugs courts and the therapeutic state: Recovering a long history (Forthcoming). The beginnings of the drug court movement can be traced back even before passage of the Harrison Narcotic Act in 1914 (Spillane and Baldwin, Forthcoming). However, the first popularized drug court is considered the Miami Dade Drug court in 1989. Nolan (2003) and others consider and call the Miami drug court the first drug court. Reinventing justice: The American drug court movement by Nolan (2003) also provides a history of the drug court movement and holds the more recent development of t he 1989 drug court as a new phenomenon. 8 Many have claimed that another distinguishing characteristic of the drug court is its nonadversarial courtroom workgroups (Colyer, 2007; Hora, 2002; Nolan, 2001; Lindquist et al., 2006). However, the


33 sanctions, and reduced charges upon completion (Berman and Feinblatt, 2001; Lindquist, Krebs, and Lattimore, 2006). This dual approach of treatment and surveillance with sanctions if necessary appealed to both conservatives and liberals alike; this support from both ideological sides has allowed drug courts to survive in the increasingly punitive public preference. The growth of the drug courts, their high political and social salience, and community support was a remarkable development. By December of 1993, the first National Drug Court Conference convened in Miami, Florida; more than 400 judges, defense lawyers, prosecutors and drug treatment special ists defined the main components for an effective drug court program (Wiseman, 2005). The first drug courts were established by local entities without federal funding (Goldkamp, 2003), but they spread nationally once federal funding was secured (Goldkamp, 2003; Inciardi, 2004). The Miami Drug Court lobbied for federal funding and the creation of an office to solely handle the funding of these specialized courts (Harrison and Scarpitti, 2002), which was achieved9. Due to their federal funding and popularity10, drug courts have spread collaborative workgroup has long existed in the criminal justice system and is evident in the frequent and historical use of the plea bargain. 9 The Violent Crime Control and Law Enforcement Act of 1994 provided federal funding for drug courts (Harrison & Scarpitti, 2002) to propagate them nationally (Goldkamp, 2003). In 1994, the National Association of Drug Court Professionals was created (Burdon, Roll, Prendergast, & Rawson, 2001), and the Residential Substance Abuse Treatment legislation passed, allocating tens of m illions of dollars to correctional facilities for treatment programs (Inciardi, 2004). A year later, Janet Reno instituted the Drug Court Program Office (DCPO) within the United States Department of Justices Office of Justice Programs, which was devoted t o providing federal support for the creation of more drug courts (Goldkamp, 2003). The DCPO continues to provide a budget, although much reduced, to the National Drug Court Institute (NDCI), which is one of eight units within the Other Federal Drug Control Programs (OFDCP) (Office of National Drug Control Policy, 2009). 10 The media continues to portray drug courts in a positive light (Alcoholism & Drug Abuse Weekly, 1997, 2004, & 2007; Behavioral Health & Accountability Alert, 2002; New York Times, 2003; Ronald, 2007; USA Today, 2008(Jan & Oct)). The public appears to still be supportive of these diversionary programs and specialized courts, i.e. Proposition 36 resulted from a California ballot initiative supported by 61% of the electorate (Inciardi, 2004: 595).


34 nationally at the local, state, and federal levels. Drug courts have become a part of normal judicial operation in numerous states; local and state funding has replaced now diminished federal funding (Goldkamp 2003). A singular model of drug courts does not exist, which poses problems for researchers (addressed later). However, they share similar goals, which are primarily to achieve both efficiency and rehabilitation through the reduction of caseloads, prison population, and substance abuse. In 1997, the NADCP published Defining Drug Courts: The Key Components, which outlined the following 10 key elements of drug courts: 1. Fusion of criminal justice case processing and drug treatment 2. Non adversarial system with the defense and pr osecution working to improve public safety as well as protect the accuseds rights in the interest of Due Process 3. Early identification and swift assignment of eligible candidates 4. Treatment and rehabilitation services 5. Regular drug testing 6. Collaboration of practitioners, judges, prosecution and defense 7. Continuous judicial and participant interaction 8. Conduct monitoring and evaluations in an effort to discern program goals and achievement 9. Continued education to promote effective planning, implementation, and operation (p. 3) 10. Partnering of public and community agencies and organizations to increase local support and drug court success These 10 elements are considered critical to drug court functioning despite significant variations in local issues such as drug use patterns, politics, law enforcement strategies,


35 judicial discretion, participant demographics and behavior, and program requirements (National Institute of Justice, 2006). Drug court research Numerous drug court studies have been undertaken in an effor t to discern their efficacy (e.g., Belenko, 1998, 1999, 2001; Deschenes, Turner, and Greenwood, 1995; Goldkamp, White, and Robinson, 2001; Gottfredson, Najaka, and Kearly, 2003; Spohn et al., 2001). Many evaluations show positive impact results for the drug court. Goldkamp, White, and Robinson (2001) determined that drug courts significantly affect offending behavior through appearance before a judge, sanctions, and participation in treatment. Although much drug court research seems positive, numerous prob lems exist, e.g. design, data collection challenges, and comparison issues. Of the 68 studies contained in Wilson et al.s (2006) metaanalysis, only five11 employed random assignment to the drug court or comparison condition, and two of the five were seri ously degraded (Wilson et al., 2006:479). Differences in monitoring can make collected data difficult to compare. In Sloan et al.s (2004) study, drug court monitoring lasted 12 months while comparison group monitoring was only 12 weeks. This monitoring l ength differential allowed for a larger number of drug tests, thus, providing the drug court participants with a larger opportunity to fail (Sloan et al., 2004). In Belenkos (2002) review, little research was found on postprogram drug use, employment, or other outcomes (p. 1643) to determine the total effect of drug courts. Many of the studies that were reviewed by Belenko (2002) were considered 11 Deschenes et al., 1995; Dickie, 2000 & 2001; Gottfredson et al., 2003; and Shanahan et al., 2004


36 inconclusive due to small sample sizes and drug court implementation issues. Attrition issues have also been problematic in drug court research (Wilson et al., 2006). Drug court program retention rates have been shown to be higher than rehabilitation rates for treatment delivered outside of the criminal justice system. National Institute of Drug Abuse (NIDA) decl ared that involuntary drug treatment is an effective rehabilitation tool when individuals complete their mandated treatment (National Institute of Justice, 2006). The force exerted by the criminal justice system on the offender to complete treatment does not appear to hinder the positive impact of the treatment (Farabee, Prendergarst, and Anglin, 1998) and results in high completion rates, with more than twothirds of participants completing treatment (National Institute of Justice, 2006). In a comparison o f a drug court with three probation systems with varying intensities of drug testing, Deschenes, Turner, and Greenwood (1995) found that the drug court program increased the proportion of offenders who completed or remained in drug treatment and that more drug court members were actively involved in drug education and treatment and attended outpatient counseling12. Overall treatment retention [in drug courts] is substantially better than in other community based treatment programs for offenders (Belenko, 2002:1643). Within groups of drug court participants, those who receive more treatment are more successful than those in receipt of less (Belenko, 2002). Participants who were exposed to more drug treatment, drug testing, and status hearings were rearrest ed significantly less often than participants with less exposure (Banks and Gottfredson, 12 Eighty percent to 90% of treatment participants leave the treatment within the first 12 months; 12 months has been determined to be the minimum effec tive timeframe. The retention rate found in drug courts is six times greater than the retention rates outside of the drug court system (National Institute of Justice, 2006).


37 2004; National Institute of Justice, 2006), including arrests for drug related charges (Listwan, Sundt, and Holsinger, 2003). Goldkamp, Robinson, and White (2007) also found that the length of time participants spent in drug court treatment was a better indicator of rearrest probability than the number of judges seen during the program. Drug court research results should be read with caution. Eligibility requirements o ften cause a creaming of the participants, meaning those eligible to participate may have a higher likelihood not recidivating when compared to the ineligible offenders regardless of their participation in treatment. For example, in Brewsters (2001) drug court evaluation, drug court eligibility requirements included no prior record for violent offenses and a nonmandatory drug offense, and the Maricopa County Drug Court only allows participation from probationers with a drug conviction as their first tim e felony conviction (Deschenes, Turner, and Greenwood, 1995). In Spohn et al.s (2001) drug court evaluation, the traditional court, drug court, and diversion groups vastly differed in their levels of offense severity. Those drug court participants had to meet various eligibility requirements including a maximum of one prior nonviolent felony conviction. This creaming potentially not only improves success rates for drug courts but excludes a population that may be in greater need of treatment and services. Research has also examined the costs and system impacts of drug courts. Belenkos (2001) review found that costs per offender for drug courts were lower than traditional courts; this was primarily due to incarcerationassociated costs. Other cost benefit analyses have also shown drug courts to save money in the long term (Carey and Finigan, 2003; Gottfredson et al., 2005)13. Deschenes et al. (1995) discovered that 13 As expected, treatment costs are higher for drug courts; however, drug courts co st society less than other means of handling drug offenders (Carey & Finigan, 2003). Gottfredson et al. (2005) found that the


38 drug courts reduced the systems workload as participants were released from probation within 12 months instead of 36 months and were kept out of the overcrowded prisons. Comparative analysis of drug courts poses its own research challenges. Jurisdictional and program variances make comparison difficult. State courts handle the majority of drug cases, but drug laws vary from state to state (VanderWaal et al., 2006). Jurisdictions differ in their structure and implementation of drug court programs (Wiseman, 2005), including target populations and services offered (Lindquist et al., 2006). As previously mentioned, a singular drug court model is nonexistent, allowing them to differ in structure, implementation, treatment, and population (Beebe, Harrison, and McRae, 1999; Bouffard and Smith, 2005; National Institute of Justice, 2006)14. Drug courts also lack a uniform method of data collection, which is one of the most severe problems facing drug court researchers. Much of the research that has been conducted to date is missing large amounts of important data, such as the seriousness of substance abuse pr oblems and clinical assessment of them (Sloan et al., 2004), as well as various offender characteristics that could affect outcomes, e.g. socioeconomic status, type of charge, education, and employment in Spohn et al.s (2001) evaluation. All studies reviewed by the National Institute of Justice in its 2006 special report were hindered by the lack of accessible data on many aspects of drug court operations (National Institute of Justice, 2006:iv). Due to the structure and operation of the criminal justice system in general, agency possession and control of Baltimore City Drug Treatment Court saved the city $2.5 million in criminal justice costs over the 3year period, and drug court participants were less likely to be on welfare than subjects of standard adjudication. For a detailed cost benefit analysis, see Carey and Finigan (2003). 14 For future research, PSM and HLM may be able to address some of these issues.


39 data can become problematic with turf issues and the variance in methods of data collection, coding, and maintenance between agencies (Belenko, 2002). Drug court participants possess lower recidivism rates than other groups. In Wilson, Mitchell, and MacKenzies (2006) metaanalysis of experimental and quasi experimental drug court evaluations that contained a control group, recidivism rates for both drug offenses and all other offenses were lower on a st atistically significant level for drug court participants. Many other studies have found lower recidivism rates of drug court participants than nonparticipants or those who did not participate in treatment (Dickie, 2000; Gottfredson, Najaka, and Kearley, 2003; Gottfredson, Kearley, Najaka, and Rocha 2005; Goldkamp, 2003). In Belenkos (2001) review of drug court reports, four of the six reports that measured recidivism post program showed lower recidivism rates for drug court participants than nonparticipa nts. Studies have also found longer time to recidivism for drug court participants (Banks and Gottfredson, 2004; Peters and Murrin, 2000). However, considerable disagreement exists regarding the measurement of drug court efficacy. Readers must note in eac h study how recidivism is defined because it varies between studies and has implications when observing success rates in general. Studies vary widely in their definition of recidivism, which has been operationalized as re arrest (any charge, same drug char ge, or any drug related charge), substance use (same substance or different substance), and time to recidivism (various types of rearrest or substance use). Only four studies in Wilson et al.s (2006) metaanalysis specifically measured drug use.


40 Recommen dations for future drug court research Although drug court research has been plagued with many obstacles throughout its history, future drug court research could benefit from new advances in statistical analysis Two innovations, in particular, could overc ome the obstacles for comparative studies. First, starting with research design, a typology of drug courts should be created to aid drug court researchers in their choice of sites. Understanding what types of drug courts exist and the characteristics of th ese types could allow for more accurate comparisons. Second, multi level statistical modeling could be utilized in future cross site impact comparisons. Depending upon the specifics of the sites, various differences between courts, such as geography, eligi bility requirements, program specifics (or even where they lie within the typology of drug courts if one ex i sted), could be used at levels above 1 in the analysis. Both of these recommendations, if exercised, could create a path for researchers and program /policy makers to embark on toward the creation of an evidencebased drug court model (or models). Mental Health Courts Mental health courts are also worthy of note with regard to VTCs. Judge Russell also based the first VTC on mental health courts due to the mental health issues many veterans face (discussed later). Mental health courts are considered an outgrowth of drug courts as many substance abuse defendants were found to possess mental health problems. Mental health courts allow offenders to participate in mental health treatment in lieu of incarceration due to the belief that the mental illness may be causing the criminal behavior. Studies have discovered that 10% to 15% of jail inmates suffer from seri ous mental illness while only 2% of the general population does (Lamb, Weinberger, and Gross 1999; Teplin 1990; Teplin, Abram, and McClellen 1996). BJS (Ditton 1999)


41 found 16% of state prison inmates and 7% of federal inmates have serious mental illness or have stayed in a mental hospital at least once during their lives. The mental health court model echoes the dual stress of drug courts on treatment and efficient case management; mental health courts are modeled after drug courts and are based on therapeutic jurisprudence (Watson, Hanrahan, Luchins, and Lurigio, 2001). The emphasis on holistic and therapeutic jurisprudence affects the psychological well being of participants and both stems from and encourages behavioral science interdisciplinary research (Winick, 2003). Mental health pr actitioners have developed the 10 essential elements of mental health courts, which are based upon the 10 key components of drug courts (Thompson, Osher, and Tomasini Joshi, 2007). The 10 essential elements (Thompson et al., 2007): 1. A broadbased group of stakeholders r epresenting the criminal justice, mental health, substance abuse treatment, and related systems and the community guides the planning and administration of the court. (p. 1) 2. Eligibility requirements are based in public safety, the communitys treatment av ailability, presence of other diversion programs for those with mental health issues, and the relationship between offense and mental health issue. 3. Participants are identified, diverted to mental health courts, and provided services as quickly as possibl e. (p. 3) 4. Participation terms award positive legal resolutions for successful program completion; are oriented in public safety, individualized, and clear; and aid in treatment participation. 5. Participant competency is evaluated when need be. Eligible indi viduals are fully made aware of requirements before agreeing to participation, and legal counsel is provided in decision making. 6. Connect participants with comprehensive and individualized treatment and strive to useand increase the availability of trea tment and services that are evidencebased. (p. 6) 7. Protection of legal and mental health information and confidentiality and constitutional rights is necessary.


42 8. Training of mental health, treatment providers, and criminal justice personnel and continual r eview and revising of mental health court process should occur. 9. Personnel (criminal justice and mental health) work together to monitor participant progress and compliance, provide individualized graduated incentives and sanctions, and alter treatment in accordance with participant rehabilitation and public safety. (p. 9) 10. Performance assessments occur, and subsequent modifications should be made. Data need to be collected to study impact and efficacy. Institutionalization of court processes occurs. Community support for the court should be created and increased. The rapidity and extent of the diffusion of the mental health court is reminiscent of the drug court experience. Four mental health courts were in operation in 1997. By 2004, 70 courts were in operation, and 125 courts were operating in June 2005 (Council of State Governments, 2003b)15. Many mental health courts are federally funded. The Bureau of Justice Assistance funds numerous mental health courts nationally, and federal funds also come from the Mental Health Courts Grant Program under Americas Law Enforcement and Mental Health Project (Public Law 106515) and the Mentally Ill Offender Treatment and Crime Reduction Act of 2004 (Public Law 108414). Mental health courts are considered an extremely recent phenomenon on which little research currently exists (Council of State Governments, 2003:1). Floridas Broward County Mental Health Court is considered by many to be the first mental health court (Nolan, 2003) and is one of the few mental health courts that has been subject to formal study and evaluation (Council of State Governments, 2003). Offenders with mental illnesses often encounter obstacles to treatment due to the lack of communication between the criminal justice system and the mental health field (Watson 15 For information on program type, location, and participant demographics, see the Council of State Governments (2003b) Mental Health Courts: A National Snapshot


43 et al., 2001). Early evaluations of Broward Countys mental health court have shown its success in integrating treatment with the jurisprudence process and tailoring treatment to the individual offenders needs (Boothroyd, Poythress, McG aha, and Petrila, 2003). Although serving 75% fewer days in jail, participants in the Broward mental health court were found to be twice as likely to receive mental health services and not more likely to commit a new offense than comparable defendants (Boo throyd et al., 2003). Unlike drug courts, only a handful of mental health courts have been the subject of inquiry. Linhorst et al. (2010) discovered the challenges of mental health court in their examination of the St. Louis County Municipal Mental Health Court, which included expanding eligibility, access to state resources and funding, and use of nonevidence based treatment. Other mental health courts have faced funding issues (Acquaviva, 2006; Redlich et al., 2006). Given the similarities of drug court s and mental health courts, mental health court research may face the same problems found in drug court research16; however, few studies have examined mental health courts to date. Several reasons may exist for the disparity between the amount of research on mental health courts and other specialized courts, e.g., drug, domestic violence, and gun courts. First, although mental illness may lead to contact with the criminal justice system by causing or contributing to certain types of criminal behavior, suffer ing from a mental illness is not a crime and all who have a mental illness are not criminals. However, illegal drug use, domestic violence, and illegal gun possession are crimes themselves and, as such, may pose more interest 16 My research on VTCs strives to avoid these problems, which is discussed in the next chapter. The effort to overc ome these previously discussed challenges is only made possible by this previous research that has brought these issues to light.


44 for academic criminologists. S econd, for the researcher, gaining access to each feature of the mental health court may be more difficult as a large component is mental health treatment and the participants are considered a vulnerable population. When working with treatment personnel an d clinicians, criminological researchers may also have a more difficult time than psychological researchers because of background and field differences, as well as credentials, cooperation, and respect. Veterans Issues It is interesting to note that spending months of continuous exposure to the stresses of combat is a phenomenon found only on the battle fields of the twentieth century Some psychiatric casualties have always been associated with war, but it was only in the twentieth century that our p hysical and logistical capability to sustain combat outstripped our psychological capacity to endure it. (Grossman, 2009:4445) Although each war is unique, the Vietnam paradigm may generally hold true17; military training and combat may have long term nega tive effects on soldiers and veterans. Currently, the veteran population is believed to face a multitude of issues. Russell (2009) listed the following issues as the primary ones faced by veterans: alcohol and substance abuse, homelessness, strained relati onships, unemployment, and mental health. Veterans suffer from post traumatic stress disorder (PTSD), traumatic brain injury (TBI), and other mental and physical conditions that can lead to substance use, abuse, and addiction (Bjork and Grant, 2009; Bremner et al., 1996; Brunello et al., 17 One challenge that these VTCs face is whether the Vietnam paradigm fits veterans returning from other wars, e.g., the Gulf W ar, OIF, and OEF. Some hold that it does fit as the frontlines of preVietnam wars have disintegrated and been replaced with every place being considered a combat zone, which is what OIF and OEF have in common with Vietnam (Steadman, 2011). Further, BJS found little differences Vietnam era (19641973) and post Cold War (enlisted in 1990 to 2004) state incarcerated veterans (see Table A 2). The only noticeable differences were the quantity incarcerated with 43,400 from the Vietnam era and 20,200 from the pos t Cold War era and median ages (53 for Vietnam era and 35 for Post Cold War). Current offenses, prior drug use and alcohol abuse, substance dependent or abusing behavior, and mental health problem rates were similar between the groups. Although the mental health problem percentage may appear to differ between the groups (47.9% of Vietnam era and 56.7% of Post Cold War), the difference was not statistically significant.


45 2001; Calhoun et al., 2008; Corrigan and Cole, 2008; Eggleston et al., 2009; Graham and Cardon, 2008; Hoge et al., 2004; Jacobson et al., 2008; Jorge et al., 2005; McFall and Cook, 2006; Ponsford et al., 2007; Stahre et al. 2009), which are also related to death, suicide, homelessness, and contact with the criminal justice system (Drug Policy Alliance, 2009). Various substance use issues are also a strong predictor of incarceration (Erickson, 2008). This section will review the existing literature on veterans psychological, substance use, and housing issues. Veterans Psychological Issues Post traumatic stress disorder (PTSD) is considered a serious health concern but is not frequently recognized and treated (Brunello et al ., 2001). Wartime trauma has existed as long as wars and societies have historically assigned names to the constellation of reactions to wartime stress and trauma. For example, soldiers heart in the Civil War; trench neurosis or effort syndrome in W orld War I; and shell shock combat exhaustion, or combat fatigue in World War II (Anderson, 2007). PTSD was finally included in the DSM III in 1980 as a result of clinical research that was conducted after the Vietnam War (Kulka, 1990; Trimble, 1985). Diagnostic criteria includes exposure to (experienced, witnessed, or been confronted by) a traumatic event(s) involving either actual or threatened death or severe injury or a threat to the physical integrity to the individual or others (DSM IV TR, 200 0)18. The response to the event must involve fear, horror, or helplessness. Symptoms of intrusive recollections, avoidant/numbing, and hyper arousal must be present for diagnosis and must last for 18 PTSD is presently undergoing redefinition in the writing of the latest update to the D SM, the DSM V. Currently, developmental manifestations of criteria are being created to diagnose across age groups. Empirical data is under analysis in a effort to determine the optimal number of symptoms needed for diagnosis (American Psychiatric Asso ciation, 2010).


46 more than 1 month. The disturbance must have functional significance, meaning it causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (DSM IV TR, 2000). Approximately 25% to 30% of Vietnam veterans experienced PTSD within the first 20 years following service (Kulka, 1990). Research on veterans from various wars revealed that PTSD can have a delayed onset surfacing after 6 months of the traumatic experience (DSM IV TR 2000) and has been documented as occurring up to 40 years later (Aldwin et al., 1994; Brunello et al., 2001; Spiro, Schnur r, and Aldwin, 1994). There is also a clinically recognized tendency to self medicate with alcohol and drugs for PTSD (substance abuse is discussed in the next subsection). Causes for PTSD vary19, but numerous studies have found a strong relationship between PTSD, combat experience, and traumatic experiences and that it is significantly related to being wounded or injured (e.g., Fontana and Rosenheck, 1994; Hoge et al. 2004; Seal et al. 2009; VHA Office of Public Health and Environmental Hazards 2008). Kulka et al. (1990) found PTSD to be prevalent in almost one in three Vietnam veterans within the first year of return from combat. Years later, Schlenger et al. (1992) found an approximately 15% rate of prevalence. Between 400,000 and 1.5 million Vietnam veterans are afflicted with PTSD (Grossman, 2009). Regarding prevalence in the most recent era of veterans, the Armys first mental health study of troops in OIF discovered one in eight soldiers reported PTSD (Associated Press, June 19 Neuroimaging has displayed structural changes in the hippocampal and limbic regions; however, it cannot be currently determined if these changes are resultant from the actual trauma or PTSD. Psychological treatments include psychotherapy, cognitive behavioral therapy, anxiety management, cognitive therapy, eye movement reprocessing and desensitization, complex psychological interventions, and other nondrug treatments (Brunello et al., 2001).


47 30, 2004). PTSD has also been linked to the support structure the soldier possesses upon return to society (Grossman, 2009). When looking at PTSDs effect on the life course, studies show that individuals may remain in low paying and low stre ss jobs, which hinders opportunities (Brunello et al., 2001; Ettner, Frank, and Kessler, 1997; Jayakody, Danziger, and Kessler, 1998). PTSD has also been found to adversely affect educational achievement (Kessler et al., 1995), marriage (Kessler, Walers, a nd Fortholfer, 1998), and having children (Ettner et al., 1997; Jayakody et al., 1998). For World War II veterans, cardiovascular death rates were higher for those with PTSD for those without the disorder (Kang, Bullman, and Taylor, 2006)20. For Vietnam vet erans, PTSD has caused increased rates of suicide, drug and alcohol abuse, and divorce (Grossman, 2009), as well as lowered cognitive abilities (Barrett et al., 1996), increased nightmares and disturbances in sleep (Neylan et al., 1998), and more physical health problems and limitations (Zatzick, Marmar, and Weiss, 1997). For veterans from post Vietnam wars (excluding OIF, OEF, and OND), PTSD has worsened mental and physical health (Ren, Skinner, and Lee, 1999), increased depression (Erickson et al. 2001), and resulted in adjustment issues (Lee et al., 1995). Traumatic brain injury ( TBI ) and other combat related injuries are additional problems plaguing veterans. TBI is a brain injury caused by sudden trauma. Symptom severity (mild, medium, moderate) is dependent upon the extent of the damage. Symptoms include loss of consciousness, confusion, headache, lightheadedness, 20 For World War II veterans, those with combat experience had a higher likelihood of diminished physical health or death 15 years after the wars end than those without combat experience. However, combat exposures negative effect was independent of self reported health after the war (Elder et al., 1997).


48 dizziness, tired eyes or blurred vision, fatigue or lethargy, change in sleep patterns, change in behavior or mood, bad taste in mouth, ears ringing, and trouble with concentration, memory, thinking, or attention (National Institute of Neurological Disorders and Stroke 2011). Zaroya (2006) found that 20% of frontline infantry suffer concussions in combat, and Hoge et al. (2008) found that 15% of Army infantry reported TBI. Hoge et al. (2008) state that other symptoms of war related issues include depression, anxiety, decreased attention span, absence of motivation, irritability, fatigue, memory loss or problems, headaches, issues sleeping, and behavioral problems. More than 20 years ago, Gabriel (1987) discussed fatigue, conversion hysteria, confusion states, obsession states, compulsion states, and character disorders that result from combat situations. PTSD, TBI, and depression have immediate and long term consequences. Tanielian et al. (2008) illustrated the relationship between various post combat disorder[s]; resources, preexisting conditions, and vulnerabilities; immediate outcomes; and long term outcomes (Figure B 1). Veterans Substance Use Soldiers use steroids, stimulants, sedatives, tobacco, and alcohol, and these social practice s or coping mechanisms can evolve into addictions (Eggleston et al., 2009). Historically, U.S. combat veterans have been at risk for substance abuse. For exa mple, dating back to the Civil War, soldiers disease referred to morphine addiction (Albin, 2001). Forty percent of OIF and OEF veterans engaged in potentially dangerous alcohol use (Calhoun et al., 2008). Smoking has also been found to increase with co mbat exposure, repeat deployments, and deployments lasting longer than 9 months (Eggleston et al., 2009). Further, many of the mental health issues veterans suffer from


49 contribute to substance abuse and addiction (e.g., Brunello et al., 2001; Corrigan and Cole, 2008; Department of Defense, 2007; Hoge et al., 2004; Jacobson et al., 2008; McFall and Cook, 2006; Ponsford et al., 2007; Stahre et al., 2009). As previously mentioned, self medication with alcohol and drugs is considered a clinically recognized sy mptom of PTSD. Vietnam veterans with PTSD have experienced significant problems with substance addiction (Bremmer et al., 1996; Jordan et al., 1991; Kulka et al., 1990; McFall, Mackay, and Donovan, 1991; McGuire, Rosenheck, and Kasprow, 2003); 75% of Vietn am combat veterans diagnosed with PTSD also had alcohol abuse or dependence issues (Kulka et al., 1990). However, actual substance abuse issues and prevalence for OIF/OEF/OND veterans are unknown for several reasons. First, onset of abuse is not always im mediate. Second, not all soldiers of this era have returned home. Finally, many to date have not sought services for reasons previously discussed (e.g., labeling or fear of labeling) Eggleston et al. (2009) reported that only 40% of Iraq and Afghanistan ve terans actually seek health services from the VA. Additionally, extensive survey research on drug use patterns that could overcome these limitations has not yet been conducted. Veterans and Homelessness Homelessness is another issue facing veterans, and it has been connected to mental health and substance abuse issues. The VA has estimated that veterans comprise one third of the U.S. homeless population. They hold that approximately 107,000 veterans are homeless daily and twice this number has experienced h omelessness sometime throughout the year. The veteran homeless population is similar to the nonveteran homeless population in that 45% are afflicted with a mental


50 illness and more than 70% have substance abuse issues. The veteran homeless population differ s from the civilian homeless population in education (more educated) and age (older) (VA, 2011). Veterans in the Incarcerated Population If these medical and mental conditions facing veterans are left untreated, the symptoms (e.g., violence, substance use, and homelessness) increase the likelihood of contact between veterans and law enforcement, as well as arrest and incarceration (Beckerman and Fontana, 1989; Erickson et al., 2008; Freeman and Roca, 2001; Lasko et al., 1999; Sherman et al., 2006). In 2004 approximately 140,000 veterans were incarcerated in U.S. state and federal prisons, and a thousand more were estimated to be in U.S. jails (Noonan and Mumola, 2007). An increase in the number of incarcerated veterans is believed to occur as veterans return from repeat and longer deployments (Reger et al., 2009), which are characteristic of the OIF/OEF/OND era. This should be a concern as prison and jail overcrowding and costs are already overwhelming. Veterans incarcerated with PTSD have higher lifetime of substance use, more severe legal problems, and poorer health than veteran inmates without PTSD (Saxon et al., 2001). Incarcerated veterans may have higher suicide risk than either veteran status or incarceration alone (Fisman and GriffenFennell, 2009; Wortzel et al., 2009), a major societal concern. Not only do veterans have specific issues, but these issues are held to be intertwined and further exacerbate other problems and dangers. Recommendations for Future Research Recommendations for more timely and effective surveillance, reporting, and treatment have been put forth. Several researchers have suggested an increase by the


51 military in education, outreach, and change in health care delivery models to increase mental health surfaces (Eggleston et al., 2009; Hoge et al., 2004). State substance abuse treatment programs have also been encouraged to make themselves available to veterans (Eggleston et al., 2009). Screening by the military for PTSD has also been recommended (Veterans Health Administration, 2000). As PTSD can take years to manifest, periodic and continual screenings are recommended. Several suggestions for future research regarding veterans issues have been made. To date, no study has combined or compared pharmacotherapy with psychosocial trea tments for PTSD (Brunello et al., 2001); this should occur in future studies. Those currently involved in combat need to be studied because the force and fighting of the current war are different from previous, e.g., all volunteer armed forces and type of warfare (Hoge et al. 2004). Veterans in this most recent era should be studied to determine time to onset for issues and what issues plague this era, whether their issues differ from previous era veterans. Veterans Treatment Courts (VTCs) VTCs have emerged in response to multifarious issues evident in the veteran population and the increase of veteran contact with the court system. Judge Russell (2009) recognized veterans and active duty as a unique population possessing the previously mentioned constellati on of needs that require services outside those offered to the regular community and in the traditional court and correctional system s. From his experience in both Buffalos drug treatment and mental health courts, Russell noted that veterans in the court responded more positively to other veterans (2009). With this knowledge and the observation of a rise in the number of veterans appearing on treatment court dockets, Russell convened the first VTC in January of 2008 in Erie


52 County (Buffalo, NY). The VTC mi ssion is to successfully habilitate veterans by diverting them from the traditional criminal justice system and providing them with the tools they need in order to lead a productive and law abiding lifestyle (Russell 2009:364). Thus, the VTC provides veteran participants with treatment for substance abuse, emotional disabilities, and mental health, as well as academic and job training, skills, and placement. Other services for housing, medical, transportation, and social support are also matched to the i ndividual veterans. Russell (2009) created 10 key components for VTCs (listed below) by modifying both the 10 key components of drug courts and the 10 elements of mental health courts. 1. Integration of alcohol, drug treatment, and mental health services with justice system case processing 2. Non adversarial approach 3. Early identification of eligible participants and prompt placement in the VTC 4. Access to a continuum of treatment and rehabilitation services in addition to veteran peer mentors 5. Alcohol and drug test monitoring 6. System of graduated responses for cooperation and noncompliance 7. Continual judicial interaction with the veteran offender 8. Monitoring and evaluation of programs 9. Educational interdisciplinary training of all involved in VTC (criminal justice and tr eatment parties) 10. Forging partnerships among the Veterans Treatment Court, the VA, public agencies, and community based organizations generates local support and enhances the Veterans Treatment Court's effectiveness (p. 367) VTCs generally operate similar to other specialized courts: eligible participants are diverted to the VTC, individual issues are identified, treatment and services are provided to address the identified issues, participants are monitored, and rewards and sanctions


53 are appropriately applied. However, VTCs offer the additional component of veteran mentors, which are required and acquired by the court, not the treatment providers. The role of these mentors is to provide support and guidance for the veteran participants. Cartwright (2011) explains why veterans need their own specialized court instead of participating in a drug or mental health court. Because an additional barrier to treatment for veterans is that many veterans perceive the civilian treatment providers do not understand the military and combat experiences, Cartwright warned that grouping veteran offenders in with civilian drug users and civilians with mental health issues may entrench those beliefs. As a standalone court, VTCs are able to create a culture of respect for ser vice and understanding of the veteran experience without unintended perceptions of pity for drug addiction or mental health issues. They are also able to link veterans to service providers who have an understanding of the military experience and to service s only available to veterans, as well as operating a veteran mentor program. Additionally, having veterans in the same courtroom facilitates support among veteran participants and may help the dissolution of the stigma they associate with treatment when they see other veterans participating. By being filled with veterans, the VTC in some ways replicates the camaraderie of the military (Cartwright, 2011:304). Numerous similarities between VTCs and drug courts and mental health courts exist. The VTC concept seems to be following the same pattern of rapid diffusion as drug and mental health courts have experienced The Buffalo VTC was the only VTC in operation as of October 2008 (Russell, 2009). According to my preliminary research, as of November 2012, there are 114 VTCs in operation in 32 states and 18 in progress of


54 being established in 9 states with other areas gaining support21. Just as was the case with drug courts, VTCs have been implemented without early evaluations to determine and address problems wit h theory, implementation, and program process. Although there are 10 key components of each, no standard model of either exists; neither set of components actually explain how the courts will be structured, implemented, evaluated, train participants, etc. or determine and identify who eligible offenders should be. Although no other research is available on VTCs today, my research (Chapter 3) suggests that, similar to drug courts, each VTC differs on myriad factors from its neighbor (e.g., participants, iden tification, services and treatments available and provided, demographics, local issues, budget and funding, structure, and program process). The challenges in drug court research that were previously discussed will most likely also pose difficulty to VTC r esearchers and are addressed later in the dissertation. Conclusion Research and literature have well documented the issues plaguing the veteran population. The withdrawal of troops from OIF and OEF in 2011 is increasing the number of veterans in America an d, thus, the integration of veterans into society, making these issues all the more salient. Given the seemingly positive results of drug courts and the similarities between drug courts and VTCs, some believe VTCs will be successful in attaining their goal s; however, as previously discussed, many problematic issues exist within drug courts and the research on them. VTCs are rapidly diffusing 21 I have been gathering information and compiling a list of all VTCs that have opened and been in operation via Google Alerts. My list was compiled from more than 450 internet reports that have posted since June of 2010. This is discussed further in Chapter 3: National Survey of Veterans Courts


55 across the nation before any systematic evaluation has been conducted. For VTCs, if their strengths and weaknesses ar e identified early, an evidencebased model could be created, which is still possible since they are still in the beginning, although rapid, stages of creation and spread. To begin to understand VTCs, this dissertation consists of two components: a national exploration of the VTC movement and an examination of a unique veterans court within this national context. This next chapter focuses on the national survey, which discerns trends in the creation, dissemination, process/structure, and implementation of V TCs nationally. Issues facing these courts across the country are also discussed.


56 CHAPTER 3 NATIONAL SURVEY OF VETERANS TREATMENT COURTS Origins and Goals Although specialized courts have been in operation across the United States for more than two decades, only one national survey of mental health courts (Redlich et al., 2006) and one national survey of domestic violence courts (Labriola et al., 2010) have been completed to date. This gap in knowledge on the national state of specialized courts poses pr oblems for specialized court researchers, program creators, and policy makers (previously discussed). To begin filling this gap, I wanted to understand the national context of the most recently created specialized court, the VTC. T his chapter presents results from the first national examination of VTCs. With this initial study, my goal is to add to the existing specialized court research by creating a comprehensive national description of VTCs through the creation of a national compendium of VTCs (populati on frame) an examination of descriptive trends across the country, and the exploration of a VTC typology. This national compendium and survey were created to examine t he research questions listed below. 1. How many VTCs exist nationwide? a) In operation b) In proc ess of being established 2. Who are these veterans in VTCs nationally? a) Demographics b) Military history c) Offenses d) Issues they face e) Are there national trends in VTC establishment, funding, goals, and procedure?


57 3. Are there national trends in VTC program structure? a) P articipation requirements b) Involvement of agencies and individuals and the roles they are proscribed c) Program process and operation d) Treatments available 4. Do implementation issues exist within VTCs? If so, what are they and how are they evident? a) Is there disagreement in goals and/or the relationship between military service and offending between members of the court and treatment providers, between treatment providers, between agencies, and within agencies? b) Are there deviations from policy and proscribed proc edures? 5. What are the personnels perceptions of participants and of the VTCs? a) Personnel perceptions of participants i) Struggles of the participants most difficult parts of program ii) Easiest for participants iii) Perceptions of impact iv) Relationships between charges military experience, and issues v) Attitudes b) Personnel perceptions of VTCs i) Challenges facing VTCs ii) What they would change 6. Does a typology of VTCs exist? If so, what categories are evident and what are the defining characteristics? Creating this national port rait allows for detailed examination of a single VTC (e.g., Study 2 in Chapter 4) within the national context created here.


58 Mixed Methodology and Multi Phase Research Design Because no research currently exists on VTCs, this study is exploratory, and a mi xed methodology was employed to achieve a more complete description of both the scope (quantitative) and the depth (qualitative) of the national VTC existence Figure B 2 depicts the multi phase research design of this study, and Table A 3 illustrates the timeline. The national survey was initially informed by previous research on specialized courts and site visits to a VTC (Survey Design subsection). After a population frame was created (Population Frame subsection), a draft of the survey was constructed and given to four Veterans Justice Outreach Specialists at various VTCs. The results were reviewed, and the VJOs provided recommendations for changes to the survey. I revised the survey and contacted all VTCs in the population (Survey Implementation subsect ion). Willing participants were sent the survey and quantitative and qualitative analyses were conducted on the data (Analysis subsection). Population Frame: The National C ompendium For this study, VTCs were defined as courts (at any level of jurisdiction) with a separated docket and one or more judges assigned to handle the cases of U.S. military veteran or active duty defendants. Because a comprehensive list of VTCs across the country did not exist at the time, I had to create a population frame. To begi n compiling a list of VTCs in operation or emerging throughout the United States, I first created a Google Alert with the terms veterans court, veterans treatment court, and veterans court legislation in June of 2010. I cr eated an initial list from 528 I nternet resources that were gathered from Google Alert between June of 2010 and May of 2012. In May of 2012, Justice for Vets, a nonprofit and nonpartisan organization devoted to connecting veterans who were involved in the criminal justice system an d


59 had mental health and/or substance abuse issues to VTCs posted a list of VTCs across the country on their website. I included and contacted those courts on the Justice for Vets website in my research. However, I believe my list is more comprehensive and accurate than theirs for several reasons (discussed in National VTC Compendium in the National Survey Results section). Finally, in May of 2012, I contacted administrative court offices in each state to determine whether the VTCs on my list existed or wer e in progress of establishment, as well as whether other VTCs not already on my list were in the jurisdiction. Three research assistants and I repeated this step in October of 2012. Table A 3 illustrates the timeline for both the national compendium and survey. Survey Design and I mplementation During the fall of 2011 and spring of 2012, I created a national survey in Qualtrics ( Figure C 1 for the final survey, Table A 3 for timeline). Qualtrics is an online survey software program that provides the follow ing benefits: automatic coding of responses, online administration of surveys to the intended audience, and does not cost the researcher any money. Additionally, this program allows the researcher to create various result files, tables, graphs, and reports ; compute statistics; and manipulate, filter, and export data with ease. T he final survey contained 70 hybrid and openresponse items. Because this study is exploratory, possible closedresponse items were created as hybrid items, allowing respondents to provide specific answers in other: specify boxes if none of the response options provided were applicable to their particular VTC. The items were divided into the following eight sections: 1. Court Description (14 items) 2. Eligibility (5 items) 3. Process (10 ite ms) 4. Veteran Peer Mentors (6 items) 5. Court Supervision (3 items)


60 6. Participant Demographics (11 items) 7. Dynamics and Outcomes (5 items) 8. Other Outcomes and Opinions (16 items) Although the ability to use the Internet varies widely within the general population, the court personnel in this studys population have access and the ability to utilize the internet (confirmed during the creation of the national compendium). Further, internet based surveys elicit better openended responses than penand paper surveys (D illman et al., 2009). The survey was created following the guidelines set forth in Dillman, Smyth, and Christians 2009 edition of Internet, mail, and mixedmode surveys: The tailored design method. Qualtrics standardizes the spacing and layout of the surv ey, which is important because these elements have been shown to bias responses (Dillman et al., 2009). For items with bipolar scale responses (measures direction and level), I used the fiveitem response categories because fiveand sevenitem categories have been determined to be optimal (Dillman et al., 2009), and these scales were fully labeled to increase reliability and validity (Krosnick and Fabriger, 1997). To motivate potential participants, I offered to send all respondents the results after the data had been collected and analyzed. Further, I explained that the results would be reported in aggregate. The importance of the survey was also explicated and the boxes for openended responses were large in accord with Dillman et al.s (2009) strategy to increase time and energy spent on the survey and encourage better responses, respectively. Once the draft of the survey was created, I emailed four VJOs I had contacted and asked if they could review my survey and provide feedback. I then revised the


61 survey, adding some quantitative items and additional response options based upon several qualitative responses provided by the VJOs and submitted the instrument and protocol for IRB review. Because participation in the survey was voluntary and all contac t information for the court s and court personnel was located publicly on the Internet, University of Floridas Internal Review Board exempted this studys protocol (#2012U 0488, Item D 1 for IRB protocol and Item D 2 for IRB exemption letter) in April, 20 12. In June of 2012, I called each VTC listed in the population frame, including the four VJOs who participated in the pilot study. Once the judge, VJO, or other VTC personnel agreed to participate, I emailed him/her the survey via Qualtrics. During the f irs t week of August, 2012, I sent follow up emails to those that did not complete the survey by the requested date of completion If the survey was not completed by September 15th, I called and/or emailed the contact s to determine whether they were still willing to complete the survey. If they were, they were given an October 1st deadline for completion; if they were not, I requested information of someone who would be qualified and possibly willing to complete the survey ( five contacts were either no longer interested or felt unqualified to complete the survey and did provide an additional contact). On October 2nd, I called the newly provided contacts and sent them the surveys, stipulating a November 1st deadline. I also updated the population frame ; three research assistants and I called court administration offices nationwide during this time. Twenty three courts in operation were added. On November 2nd, four research assistants and I contacted these twenty three courts and the participants that did not


62 m eet the November 1st deadline. A final deadline of November 30th set with the explanation that the survey would be closed on December 1st, so that analysis could begin. Reminder phone calls and emails were made November 2628 by three research assistants. I closed the survey on December 1, 2012. Analytic Plan: Quantitative and Qualitative Methods The primary purpose of this study was to provide a comprehensive portrait of VTCs nationally Therefore, most of my results are descriptive, consisting of percentages of respondents responding to items that correspond to my research questions regarding participants, establishment, funding, goals, structure, process, implementation, and challenges. I am interested in convergence and dissimil arity in crosssite resp onses (i.e., similarities and differences between operational VTCs across the country). In addition to discovering trends in VTC elements across the country, I was also interested in exploring a whether a typology of VTCs existed. Using cluster analysis1, this study also examines whether certain types of VTCs exist across the country, specifically whether VTCs group together into profiles that contain certain characteristics (discussed in detail in the Typology section) resulting in a VTCs typology. Clus ter analysis is a data grouping statistics technique ( Schiopu 2010), which helps to reduce heterogeneous data sets one heterogeneous data set in this study 1 C luster analysis, discriminant, latent class, and latent profile analysis organize data into groups based upon certain independent variables. For this study, cluster analysis is more appropriate than discriminant analysis because no knowledge exists regarding the number of clusters. Discriminant analysis classifies items into already existing groups, and previous research does not exist regarding types of VTCs or specialized courts. Further, I have a mix of categorical and continuous variables. Latent class analysis utilizes only discrete variables, while latent profile analysis only uses continuous variables. Thus, due to the combination of variables in this analysis, cluster analysis is the most appropriate met hod to employ in this case.


63 into similar groups by maximizing variability between groups while minimizing variability within gr oups (Lattin, Carroll, & Green, 2003). It is one of the most utilized methods for typology construction; although its origin is in psychology and anthropology, it has been employed for typology construction in economics, biology, mathematics, political science, geography, and sociology, (Rudra, 2007) as well as marketing Recent examples include the use of the two step clustering method to group students on emotionally intelligent leadership behaviors (Facca and Allen, 2011), to identify profiles of bank customers (Schiopu, 2010), and to segment subgroups of college student based on coping styles (Eisenbarth, 2012); the k means clustering method to classify subgroups of psychosocial profiles in low income substance abusers in a community recovery center (M endelson et al., 2013) and distinct neighborhood types (Song and Knaap, 2007); and the hierarchical clustering method to segment welfare regimes in less dev eloped countries (Rudra, 2007). Cluster analysis is an exploratory analytic technique due to the fact that a researcher does not know the number of clusters before analysis; it is not simply a method of classification. Classification assigns object of interest (e.g., cases, countries, people) to predetermined classes, while clustering both defines the g roups and assigns objects to these newly defined groups ( Schiopu, 2010). For example, discriminant analysis is solely a classification method as it classifies items into predetermined groups. The purpose of cluster analysis is to determine both groups and which objects of interest belong in those groups, and it can produce a number of clusters that do not represent the natural modality of the data (Limitations). However, this tool can help researchers understand how to group certain people, products, or events (Punj &


64 Stewart, 1983) and what properties or mechanisms create differences and similarities between these objects of study (Wilks, 2006). In this study, the goal is to explore whether VTCs can be grouped, and if so, what properties are instrumental in creating these groups. To determine whether certain types of VTCs exist nationally and because this is exploratory, various combinations of variables both categorical and continuous were tested (all variables tested are defined and reasons why they were chosen are explained in the Typology Variables subsection of the VTC Typology section). For each combination presented, distance measures are used to determine how different (or far apart) the VTC profiles were from each other at different stages of clust ering (Burns and Burns, 2009; Noruis, 2012). These measures were used to group similar courts based on the com binations of variables chosen to create clusters. Specifically, two step cluster analysis was employed because it utilizes a scalable cluster a nalysis algorithm, which can handle a combination of continuous and categorical variables (SPSS, 2001)2. The analysis was conducted in Statistical Package for the Social Sciences (SPSS) because the twostep method has been especially designed and implemented in SPSS ( Schiopu, 2010:67). As the name indicates, twostep cluster analysis consists of a twostage process: 1) preclustering into subclusters 2) clustering (Burns and Burns, 2009; Noruis 2012; SPSS 2001 ). For this analysis, the distance measure must be set to log likelihood because it is the only distance measurement available for this combination of variables ( Noruis 2012). For the log 2 The distance measures used in hierarchical and k means clustering cannot be used for analysis of the combination of both types of variables. Hierarchical clusters use a distance matrix between case pairs, and k means clusterin g moves cases in and out of predetermined clusters, but there are no known clusters in this study ( Noruis, 2012; Steele et al. 2008).


65 likelihood distance measure, cases are assigned to the cluster that will produce the largest log likelihood. To determine the importance of variables whether a variable distinguishes clusters from one another the critical value test (also known as the critical line test) is employed. Chisquare is calculated for categorical variables, and t statistics are calcula ted for co ntinuous variables. Variable importance plots graphically illustrate the impact of the variables on cluster differentiation. The X axis is the chi square for categorical variables or the t test for continuous variables. The Y axis is the variable list. If the bar of the test statistic exceeds the critical value line, the variable is important in distinguishing clusters. Researchers can specify the number of outcome clusters desired, but because this analysis is exploratory, I did not specify the number of clusters to be created but opted for Schwarzs Bayesian Criterion (BIC) to determine the optimal number of clusters. BIC is computed for each possible number of clusters, and the smallest BIC indicates the most appropriate number of clusters. Howe ver, the BIC decreases as the number of clusters increases, so the best fitting model has a large BIC ratio change and a large distance measure ratio. Further, I tested combinations with and without outlier handling; the outlier handling option creates a c luster for cases with atypical values (those that do not fit well in any cluster). Outlier handling occurs between step one and step two3. Qualitative data from solely openended questions were collected to both inform certain quantitative responses (e.g. help in interpretation and further explanation of why or how) and to explore unknown elements of VTCs. My goal with the inclusion of qualitative response options (solely openended) was similar to that of the quantitative 3 For a more detailed explanation of the twostep clustering method please see SPSS (2001) and Schiopu (2010).


66 data, to be able to identify pos sible themes across sites. In line with this studys mixed methodology, some of these themes, as well as the openended responses in hybrid questions, were later quantified for use in quantitative analysis (Creswell & Plano Clark, 2011; Tashakkori & Teddli e, 2003). Because each qualitative study is unique, the analytical approach used will be unique (Patton, 2002: 433). Thus, numerous coding techniques were reviewed before coding began. Elemental coding methods were employed in this study, specifically structural coding. Structural coding was utilized because the data ca me from survey research that has multiple participants and both standardized and semi structured items and is exploratory in nature with the goal of determining categories (Fowler, 2001; Saldaa, 2013; Wilkinson & Birmingham, 2003)4. The steps included data organization, reading and memoing, describing codes/themes, and classifying into codes/themes (Creswell, 2013). Response Rate Personnel from 79 VTCs responded to the national survey, resulting in a general response rate of 69% ( total of 79 responses divided by the population of 114). Additionally, I calculated the response rate using the American Association for Public Opinion Researchs (AAPOR) Response Rate Calculator which differenti ates between response, cooperation, refusal, and noncontact rates This calculation standardizes response and nonresponse rates, allowing for rate comparison across research surveys of varying topics and a dministration modes (AAPOR, 2011) Because this was an 4 Holistic coding is another type of elemental method similar to structural coding. However, holistic coding is not guided by a research question or topic, and this survey is aimed at answering research questions and creating categories.


67 I nternet survey, I used the AAPORs Standard Definitions Response Rate Calculator V3.1 for surveys conducted via Internet, telephone, and mail (AAPOR, 2011). Table A 50 depicts the outcome rate categories All 79 VTCs that completed the survey were cat egorized under Category 1. Category 2 contains 32 VTCs that did not participate in the survey for various reasons. Specifically, 19 VTCs did not return any voicemails or contact attempts (message not returned), and eight VTCs initially agreed to participat e but never completed the survey (break off/implicit refusal). I was unable to make contact with appropriate personnel from three VTCs (noncontact) and three VTCs did not have personnel present who felt qualified to complete the survey One VTC refused to participate (refusal and breakoff), and one VTC did not have Internet access (location not allowing interview). The AAPORs Response Rate Calculator calculated the response, cooperation, refusal, and contact rates; and these values are listed in Table A 51. For the response rate, only Response Rate 1 (RR1) is reported because only categories 1 and 2 were represented in my response and nonresponse types. Because of this, the calculations for RR1, Response Rate 2 (RR2), Response Rate 3 (RR3), and Respons e Rate 4 (RR4) are identical. RR1 also known as the minimum response rateconsists of dividing the total number of completed interviews in Category 1 by the eligible interviews in Category 2 and the unknown eligibility in Category 3 (not present in my data). The RR1 for this study is 69% which is the same as my original calculation. The cooperation rate represents the proportion of cases interviewed of all eligible cases contacted (AAPOR, 2009). Cooperation Rate 1 (COOP 1) also known as the minimum cooper ation rateis calculated by dividing the number of completed


6 8 interviews in Category 1 by the total of Category 1 plus the total of eligible noninterviews (i.e., refusal, refusal and breakoff). The COOP1 is 86% Cooperation Rate 3 (COOP3) is also reported, which is calculated in the same way as COOP1 but counts those unable to complete the survey as unable to cooperate. COOP3 for this study is 90% a 3% increase and the highest of all the rates thus far. Refusal rates refer to the percentage of cases that refused to participate or brokeoff from participation. Refusal Rate 1 (REF1) is created by dividing the number of refusals by the total number of interviews completed, nonreponses, and cases where eligibility is unknown (AAPOR, 2009). REF1 is the only refusal rate reported because only Categories 1 and 2 are represented; thus, the other refusal rates are identical to REF1. REF1 for this study is eight percent. Contact rates are the percentage of cases reached by the research team. Because only Categories 1 and 2 are represented and all contact rates calculated were identical, only Contact Rate 1 (CON1) is reported in Table A 51. CON1 for this study is 81% Overall, the response rate of the populatio n was high at 69% which is substantially higher than the 30 % to 35% of samples seen in the literature (e.g., Lozar Manfred et al., 2008; Shih and Fan, 2008). The West h ad the highest response rate (80%), followed by the Midwest (78% ). The lowest response rates came from the South and the Northeast ( 60% and 56% respectively ). The general nonresponse rates are discussed further in the Limitations section. T he cooperation rates were higher than the response rates at 85% and 90% The contact rates were the second highest of the rate


69 types at 81% The refusal rate was the lowest at eight percent. VTCs were generally willing to participate in the survey. Results and Discussion for the National VTC Compendium The creation of the national VTC compendium addresses the first research question and its two components: 1. How many VTCs exist nationwide? a) In operation b) In the process of being established As of November 1st, 2012, my list indicated that 114 VTCs were in operation, two were in transition, and one was on hold5 in 32 states and that 18 were in the planning stages in nine states (Table A 4). Table A 5 depicts the regions6 where the VTCs are in operation, and there appears to be a similar number of courts spread throughout the regions (ranging from 25 to 32 VTCs) but variations exist across states with VTCs (ranging fro m one to 13)7. Regarding regions, VTCs are operating across all regions with 27 in the Northeast (24% ), 25 in the South (22% ), 32 in the Midwest (28% ), and 30 in the West (26 % ). While Table A 4 depicts the number of courts in states in table form, Figure B 4 (Appendix B) pictorially displays the VTCs in operation across the nation. States with the highest number of VTCs are New York with 13 and Pennsylvania with 12 (each with approximately 11% of the VTCs nationwide), and Texas, Wisconsin, and California each follow with nine (each with approximately 8% of VTCs nationwide). As seen in Figure B 4 and Table A 6, the majority of states with operating VTCs (59% 19 5 This court reported being on hold because it did not have any participants. 6 Regions defined here are the same as those defined by the United States Census (i.e. West, Midwest, South, Northeast). See Figure 31 in Appendix B. 7 The 18 states without VTCs are not included in thes e calculations.


70 states) have only one or two VTCs. Specifically, 10 states (31% ) have one VTC, and nine (28% ) have two (Table A 6). In summation, my compendium contains 44 courts not included on the Justice for Vets Internet list (Table A 4). Further, several court contacts for their list of VTCs were incorrect and four of the VTCs they listed did not exist. The compe ndium creation allowed for an examination of the amount of VTCs in existence, as well as VTC location and frequency of existence within locales. VTCs have become another popular specialized court adopted in many states, specifically 32 states (64%), which are listed in Table A 5. The VTCs are fairly evenly dispersed across regions, ranging from 25 to 32 (Table A 5); however, the number of states within regions varies. Although the Midwest has the most VTCs within its region (32), only 58% of the states within the Midwest have a VTC in their state. The West has the second most VTCs within its boundaries as a whole (30) but has the most states (11) and the highest percentage of states with at least one VTC (85%) in its region. The Northeast has the third most VTCs in its region (27) but has the fewest number (four) and lowest percentage of states with at least one VTC (44%) in its region. Finally, the South has the fewest VTCs (25) in its region but has the second highest number of states (10) and percentage of states with at least one VTC (63%) within its region. Additionally, the number of VTCs within each state varies, ranging from zero to 13 (Table A 5). The two states with the most VTCs within their states, New York with 13 and Pennsylvania with 12, are bot h located in the Northeast region. Although the study results allowed for this geographic portrait, the reasons why VTCs are located or are so prevalent in certain regions or states is unknown as these were not goals of this survey. A future examination of these reasons could provide more depth to our understanding of


71 VTCs, and specialized courts in general such as knowledge related to their emergence, proliferation, and sustainability. The results for the trends in the number of VTCs in operation within various states (Table A 6) are expected. As seen in Table A 6, more than half of states with VTCs (59%) have no more than two VTCs currently in operation. With the first VTC being established in 2008, VTCs can still be considered new to the specialized court scene, so lower numbers in states should be expected. Results and Discussion for National Trends in VTCs Research questions 2, 3, 4, and 5 are addressed in this section using results from the national survey. Because one member from each participating VTC (e.g., judge, VJO, public defender, prosecutor, probation officer) responded to the survey (n=79), it is important to keep in mind that the responses to items such as goals, challenges, issues facing participants, and implementation are the perceptions of the respondents. Therefore, the available respondent characteristics are reviewed initially. Then, the findings are presented and discussed in the following order: veteran participants, VTC elements, implementation issues, perceptions of participants, and perceptions of VTCs. Because the many elements measured using openended and hybrid items produced numerous responses, the following subsections report and discuss the major findings (or results of the majority), while the tables in Appendix A and the figures in Appendix B display the full range of responses in detail. VTC Respondents Table A 7 displays the characteristics of the 79 respondents who completed the survey about their respective VTCs Slightly more than half of the respondents (52% ) are m ale, and one third (33% ) are either program or court coordinators The second


72 most prevalent occupations (each at 15% ) are VJOs and some type of administrator (i.e., administrator, director, and superintendent). Judges and upper level support staff each consisted of 9 % of the respondent sample. Other respondents were probation supervisors/officers (6 % ), attorneys (5 % ), court officers (4 % ), and mentor coordinators (1 % ). Two respondents ( 3% ) did not provide their sex and occupation information. Veteran P artic ipants In openended items, respondents were asked how many veteran participants they currently have in their VTCs (active cases) and how many veterans had a participation offer extended to them but decided not to participate in (initial opt out), graduat ed from (graduate), and dropped out after agreeing to participate in (drop out) their VTC. They were also asked how many veterans their VTC had kicked out (terminated) and how many veterans returned for participation after they had previously graduated, were terminated, or had opted out (returner). All 79 respondent s answered these items. Table A 8 reports the results for the number of veterans per status and the percentage of each status for two categories: 1) total participants (n=3,649) 2) ever offered participation (n=4,347). This second category of ever offered participation includes the initial opt out group, while the first category, total participants, excludes this group because they chose not to participate from the start. Most veterans fell under the active case status (current participants) with 1,869 veterans, and these current participants were the largest groups in both the total participant (51% ) and ever offered participation (42 % ) categories. Graduate status was the second largest at 1 ,227, consisting of more than a third (34% ) of the total participant group and more than one quarter (28% ) of the ever offered participation category. The


73 fact that active cases outnumber all other categories indicate that VTCs are actively operating with increases in new members. Initial opt out was the third most popular status, containing 698 veterans, which means that 16% of veterans ever offered participation chose not to participate in VTC. Termination numbers were lower at a total of 432 participant s (10 % of ever offered, 12% of total participants). No more than 3% of veterans in either group dropped out (121 veterans), and no more than 2% of veterans in either group returned to VTC after any type of participation (76 veterans). A minority (16%) of t he 4,347 veterans that were offered a chance to participate in VTC declined the offer (Table A 8). The various legal and financial incentives (Table A 28) may be a reason why the majority (86%) opt to participate. One of the VTCs that has not had any initi al opt outs to date is located in California, and the respondent stated that, although every veteran that was offered participation chose to participate, a common discussion about whether to participate centered on what the actual time spent incarcerated w ould be if the veteran chose not to participate. T he ability to max out time in Jail and be released without probation. The California Prison System is current l y sending state prisoners to county jails due to overcrowding (CA AB 109 Criminal Justice Realignment). Offenders are being sentenced up to three years in county jails and are only required to serve 30 50 percent of the sentenc e. Future research should explore why veterans choose to participate; this survey did not gather explicit information in this area. However, my survey did gather information on why veterans chose not to participate (initial opt out). VTC respondents were asked why veterans opted to not participate and why participants dropped out of their VTCs. These items were open ended, and the respondents were not limited in the number responses they could


74 provide. Reasons why veterans opted and dropped out and the percentage of VTCs that reported these reasons are listed in Table A 9 Note, the responses listed are not mutually exclusiv e, and the percentage calculations are out of reduced samples8. Several reasons for opting and dropping out emerged as the most widespread reasons across VTCs. The program being too rigorous was the most reported reason across courts for both initially opt ing out (38% of VTCs) and for dropping out (48% of VTCs). Specifically, VTCs reported that veterans did not want to make the commitment or thought the program was too hard, had too many restrictions, or was too long, too much work, or more rigorous than normal case processing. This supports Morris and Tonrys (1990) proposition that community based sentences can be equivalent to incarceration, as well as previous findings where offenders chose prison over an intensive supervision program one third o f the time (Petersilia, 1990), preferred prison to probation because probation was stricter (Crouch, 1993), and believed intermediate sanctions to be just as punitive as prison (Petersilia and Deschenes, 1994). The participant not wanting treatment was the second most common reason across VTCs for both initially opting out (16% ) and dropping out (25 % ) (Table A 9) Specific reasons included not wanting to go to treatment and not wanting to remain abstinent. However, continuing illegal use/abuse of a substance did not fully comprise this category. One VTC reported that at least one of the veterans who chose not to 8 Sixty nine of the 79 VTCs (87 percent) had veterans choose not to join their programs, so the reduced sample size of 69 was utilized for the initial opt out category, and only 44 of the 79 VTCs (56 percent) had veterans drop out of their programs, so the reduced sample size of 44 was used for the drop out category. Some VTCs did not know why veterans opted out (28 percent) or dropped out (14 percent), but they are included in the respective sample sizes because these VTCs did report that v eterans had dropped and opted out. Finally, one VTC refused to provide reason(s) why veterans had dropped out of their program, and, again, this court remained in the sample because it did have veterans drop from their program.


75 initially participate did not want to participate in treatment because he/she wanted to continue to legally use marijuana. T he veteran had the desire to continue marijuana use under the Oregon Medical Marijuana Program. VTC program creators, directors, and teams should keep in mind the legal status of substances when creating and reevaluating their eligibility and participation requirements. This is not to suggest that because a substance may be legally ac cessible to certain individuals its use should be permitted by the VTC; substance abusers in treatment need to remain sober and should be required to do so and participate in treatment by the VTC per its general mission regardless of the substances legality. However, if a participant does not have substance abuse issues or issues related to or exacerbated by the use of legal substances in moderation (as deemed so by a qualified treatment counselor), the veteran should not be entirely banned from legal use and participation in the program because the VTC would be excluding additional veterans in need and considering legal behavior to be unlawful. The third most reported reason across VTCs was agai n, the same for opt outs (9 % ) and dropouts (11 % ) that the participant thought they would get a better deal in traditional criminal court (Table A 9) Specifically, respondents reported that veterans did not feel guilty, did not want to plead guilty, felt the actual sentence [was] shorter than treatment, or believed the deal was not good enough for entering for into Veterans Treatment Court to warrant the increased supervision. A recommendation for VTCs requiring guilty pleas may be to offer for cer tain offenses, better sentencing options or not require a guilty plea for VTC participation as it deters prospective participants, which was also a suggested change by 7% of respondents ( Table A 35 ).


76 More than one quar ter (28%) of respondents did not know why veterans chose not to participat e. As nearly three quarters (73% ) of VTCs are currently attempting to track their outcomes and progress of par ticipants, VTCs should begin to track why prospective participants did not choose to participate for two reas ons. First, if a VTC is in need of more participants as som e, although few no more than 4% (Tables 16 and 17) are, program policies may be modified where possible to attract more participants without compromising program integrity. Second, these initial opt outs understanding why veterans initially opt out and who these veterans arecould be used as a comparison group for intermediate and long term outcome evaluations. Active and graduate are the most popular VTC case statuses. More than half of the partici pant cases to date ( 51%) are active (Table A 8 ). This could be related to the fact that most programs are a minimum of 12 or 18 months in length and have begun within the last two years, specifically 33% began in 2011 and 19% began in 2012 (Table A 17). Cu rrently, graduation rates (34% ) are the second largest percent age of case statuses, and, further, graduations are nearly three times higher than termination (12%) for participants. Drop out rates were the second lowest of all case statuses at 3% (Table A 8 ), and nearly half (46% ) of VTCs stated that no veteran has dropped out of their programs. Upon examination of the graduation, drop out, and termination rates, r etention rates appear high to date, but this study did not address why participants continued participation (although effective and helpful components of VTCs are discussed later). Thus, future research should specifically explore the causes for this whether it be a function of the length of time the VTC has been in oper ation or other reasons becaus e, although it is too early to know VTC efficacy, drug court research


77 (previously discussed in Chapter 2) indicates that the more time in treatment is related to longer time to recidivism and lower recidivism rates. Table A 10 illustrates the prevalence o f reasons for termination across VTCs. Constructed as a hybrid item with seven response options and an eighth openended other, please specify option, the respondent could mark and list as many reasons as he/she wished, so the reasons listed are not mutually exclusive. Sixty four of the 79 VTCs reported that they had terminated veterans to date, so the sample for Table A 10 has been reduced to 64. Clost to two thirds (61% ) reported termination for failure to participate in treatment. Nearly half of all VT Cs that had terminated participants reported termination due to failure to appear in court (47% ) or for violation of probation (42% ). Approximately one third of VTCs reported termination for positive drug screens (33 % ). Regarding rearrest type, termination was reported by nearly one third for rearrest for a different offense (30 % ) and more than one quarter for rearrest for the same type of offense that brought the participant to VTC (27% ). A lthough dropping out occurred in only 44 VTCs (59% ) and participants were terminated in 64 VTCs (81% ), the reasons for each were explored. Similar to the initial opt out, the reasons most popular among VTCs for drop out were the program being too rigorous (48% ) and the participants not wanting treatment (25% ), located in Table A 9 Specific reasons under the general description of too rigorous included participants feeling that the program was too time consuming, was too lengthy, or would require too much work or the reporting and monitoring requirements were too intense or required too frequently. Reasons for not wanting treatment included not wanting to engage or participate in treatment, not believing there was a problem so did not want treatment,


78 and wanting to continue use and not be involved in treatment. The majority of VTCs (61 % ) reported nonparticipation in treatment as a cause for termination (Table A 10), which is expected because 100 % of VT Cs required treatment (Table A 23). Failure to appear in court was reported as a termination cause by nearly half of VTCs (Table A 10); again, this is expected as frequent court appearances are required by 92% of VTCs (Table A 23). Violation of probation was the third most popular reason for termination among VTCs at 42% This termination cause may be a popular reason a mong VTCs because probation violations cover a wide range of behaviors, as well as the fact that the majority of VTCs (55% ) require participants to be on probation (Table A 23). Although testing positive for substances was reported by 33% of VTCs (Table A 10), the respondents explained that participants are not terminated for a single positive screen but that termination results from continued noncompliance and nonresponsivity to treatment evidenced by multiple failed drug tests: Only if continuous, and t he participan t does NOT respond to treatment; It would take several times of this [positive drug screen] happening, all treatment options would be exhausted first; As a treatment court a first [positive drug] test result would never result in terminati on. But ongoing [drug] use without participation in treatm ent could result in termination; This [positive drug screen] has to be a repeated offense. Case by case basis and only when all tx [treatment] options are exhausted will this result in termination. A specific number of failed drug tests was not provided by any respondent. Additionally, nonparticipation in treatment needs to be a cons istent behavior for termination: This [not participating in treatment] has to be a repeated offense. Case by Case basis; Repeated [nonparticipation in tr eatment results in termination]; Continued non compliance with


79 program rules; If continual lack of treatment engagement occurs, cannot stay in the therapeutic court. These explanations are evidence that VTCs appear to embody the medical model of addiction, which views addition as a disease and relapse is a part of the process. Without compromising program integrity adjustments to the program based on the drop out and termination reasoning cannot be recommended. However, as previously suggested for the initial opt outs, these drop out and terminated veterans should be tracked for possible utilization as comparison groups in future research. The returner rate is the lowest percentage of participant cases ( 2% ), but the term returner here refers to veterans who have previously participated in VTC and have now returned to participate again after graduation, being terminated or dropping out. Returner does not mean returning to criminal justice system or re offending Although these rates may appear to suggest low recidivism rates, it needs to be clear that they do not if recidivism refers to anything other than returning to participate in VTC again. Table A 11 displays the demographics of the total VTC partici pants (n=3,649) in 79 VTCs across the country. These items were openended, requesting participants to provide a percentage for each demographic category in their VTC. The average percentages and standard deviations are listed in Table A 11 The majority ( 92% average) of total participants are male. Although not all VTCs reported having female participants, the majority, specifically 61 (77% of the 79 VTCs) reported that they currently have or have had female veteran participants in their VTCs. The racial/ethnic majority is white (62% average) with African American being the second most predominant (30% average) across VTCs. The most prominent age range among the VTCs were 41 to 50 (23% average), 31 to 40 (22% average), and 21 to 30 (20 %


80 average), specifical ly 26 to 30 at an average of 21% and 21 to 25 at an average of 19% An average of 90% of participants were veterans, while activeduty reservists averaged 8 % average and active duty personnel averaged 3% The OIF/OEF/OND era was the most predominant, averaging 39 % followed by the Vietnam era, which averaged 25% The Army was the most represented branch within the VTCs, averaging 48% followed by the Marines, averaging 30% An average of 71% of the veteran participants was reported to have some type of trau ma experience. Although not included in Table A 11 the minimum values were 0 for all categories except male veteran participants (minimum of 16 % ), white veteran participants (minimum of 14% ), and veteran participants with trauma experience (minimum of 15 % ). Thus, all VTCs reported having males, whites, and veterans with trauma experience in their populations. In comparison to the veteran population reported by the U.S. Census Bureau (2009, 2010), VTC participant demographics are both similar and different than the veteran population. The veteran population percentages for sex and race/ethnicity were calculated from the total numbers provided in Figure B 179 (U.S. Census Bureau, 2009). Percentages of males and females were similar between the two po pulations Females constituted 7% of the veteran population in 2009 (calculation from Figure B 17) and an average of 6% of the VTC participant population ( Table A 11). However, excluding Asian and Pacific Islanders10, minorities appear to be overrepresented in the V TC population in comparison to the veteran population. Although the majority of the veteran population and VTC partici pant population were both white, 85 % of the veteran 9 Total numbers were employe d instead of the 18 to 64 range because there were VTC participants over the age of 60 (12 percent). 10 Asian and Pacific Islanders make up 1% of the veteran population (calculation from Figure B 17 ) and 1% of the VTC participant population.


81 population is white (calculation from Figure B 17), while an average of 62% of the VTC participant population is white. Eleven percent of the veteran population is African American (calculation from Figure B 17), and average of 30% of the VTC participant population is African American. Veterans of Hispanic or Latino origin constitute 5% of the veteran population and 12% of the VTC participant population. It could be argued that an overrepresentation of minorities in VTC should be anticipated because the re is an overrepresentation of minorities in the criminal justice system Although the cri minal justice system should never strive for an overrepresentation of any demographic, it is important to note that based on these numbers, it appears that minorities are not being excluded from the VTC option because the overrepresentation is still prese nt in this population With regard to age comparisons, the ranges between the populations are matched as closely as possible ( challenges are discussed in the Limitations section) using Table A 11 for the VTC population and Figure B 18 to calculate percent ages for the veteran population. The VTC population is younger than the veteran population with a larger percent age of the VTC population being in their teenage years, 20s, 30s, and 40s. Percentages of veterans in their 50s were almost equal between the po pulations. A larger percentage of veterans at least 61 years of age belonged to the veteran population. Specifically, 3% of the VTC population were between the ages of 18 and 20, and less than 1% of the veteran population were under 20 years old. Twenty th ree percent of the VTC participant population fell between the ages of 41 and 50, while 14% of the veteran population were reported to be between the ages of 40 and 49. Twenty two percent of the VTC population were between 31 and 40 years of age, and 8% of the


82 veteran population were between 30 and 39 years of age. Twenty one percent of the VTC population fell with in the 26 to 30 age range, and 3% of the veteran population were within the 25 to 29 age range. Nineteen percent of VTC participants were between the ages of 21 and 25, while 1% of the veteran population were reported to be between 20 and 24 years of age. Sixteen percent of the VTC population were 51 to 60 years old, and, similarly, 17% of the veteran population were 50 to 59 years old. Twelve perc ent of the VTC population was at least 61 years of age, and 55% of the veteran population was at least 60 years old. Ability to offend, agecrime curve, willingness of law enforcement to arrest, recent influx of veterans from OIF/OEF/OND, and perceptions o f treatment may contribute to the overrepresentation of younger generations in the VTC population Figures 142 and 143 provide era information for the veteran population, which were used in calculations for comparison to the era demographics provided by VTC respondents in Table A 11. One quarter (25 % ) of the VTC population are Vietnam era veterans and 33% of the veteran population served in the Vietnam era. Because Gulf War veterans in Figure B 19 include veterans service from August 2, 1990 to 2010, the Gulf War numbers from Figure B 18 (5,737) will be utilized. A n average 15% of VTC participants were from the Gulf War, while 25% of the veteran population served in the Gulf War. However, 39% of veterans in VTC belong to the OIF/OEF/OND era, while this era constitutes only 12% of the veteran population as of 2010. In comparison to the veteran population, Vietnam and Gulf War era veterans appear to be under represented in the VTC participant population, while OIF/OEF/OND era veterans are over represented in the VTC population. One possibility for the disparities between


83 populations for this era may be the dates these populations were recorded. The OIF/OE F/OND era percentages for the VTC population were recorded in 2012, while the OIF/OE F/OND veteran popul ation was recorded in 2010 and it may be slightly higher today Although those numbers may not be as current as possible, the disparity of percentages can still be of interest because the presence of OIF/OEF/OND era veterans in VTC is more than three times that of the OIF/OEF/OND era presence in the general veteran population. In addition to the 2010dated demographic for the veteran population, an additional reason for this disparity may be the fact that VTCs do accept active duty soldiers and reservists. However, the average percentage of activ e duty soldiers in VTC is only 8% an d of active duty reservists is only 3% To determine which issues veterans in VTCs are facing and whether these issues differed by sex, respondents were asked, in openended item s, what percentage of male and female veterans faced each issue in their VTC. All 79 VTCs responded. Table A 12 displays the average percentage of males and females facing substance abuse, homelessness, mental health, family issues, and aggression/violence. Substance abuse appears to be the most prevalent issue for both males and females with reported averages of 81% of males and 68% of females having substance abuse issues, and mental health is the second most prevalent for both sexes with averages of 68% of males and 59 % of females having mental health issues. Averages of 54% of females and 56% of males were reported as having family issues, making family issues the third most prevalent problem challenging both male and female veterans. For females, the fourth most widespread issue reported was homelessness (average of 31% ), while anger/aggressive/aggressive behavior is the fourth most prevalent issue for


84 males (average of 44 % ). The least prevalent issue (in relation to the issues presented) for female veterans is aggressive/violent behavior, averaging 25% and for male veterans is homelessness, averaging 34% Although minimums and max imums are not listed in Tables A 12 and A 13 these values did lend to a further understanding of some VTCs. Each VTC estimat ed that at least 14% of male participants had substance abuse issues and that a minimum of 4% of their male participants had mental health issues. The minimums for the rest of the items for males and females were zero. Some VTCs also reported maximum values of 100% for males with substance abuse, mental health, family, or homelessness issues, as well as values of 100% for females with substance abuse, mental health, family, anger/violence, and homelessness issues. For offense types, all minimum values for o ffense types for both males and females were zero. However, some VTCs did report that 100% of their male participants were there for drug offenses and that 100% of their female participants had drug, DUI/DWI, theft/fraud, or nondomestic violent charges. T he literature reports that homelessness, mental health, and substance abuse issues are the main issues that challenge veterans. The VTC participant results support the literature but require discussion. As previously reported, substance abuse, mental healt h, and family issues were the most prevalent issues among male and female participants (issues with this item are discussed in the Limitations section). Because homelessness is the most publicized veterans issue by the VA, it is interesting to note that i t ranks as the fifth most prevalent issue for males and the fourth most prevalent issue for females out of the five options provided. It should also be noted that every VTC reported at least 4% of their males had mental health issues and 14% had


85 substance abuse issues, while the minimum for all other categories including homelessness, was zero. The VA has recently made strides to acknowledge and treat the ment al health issues veterans have, and it should continue attempts in these areas specifically by mak ing mental health care and substance abuse treatment more accessible and reducing restrictions (overview of barriers to VA services in Chapter 2), including VA eligibility requirements, in an effort to adequately treat those in need. Several respondents whose VTCs have been in operation for several years commented on the changes they have noticed over the years in their populations demographics and issues. Specifically, when their VTCs first began, the majority of participants were from the Vietnam era, whereas today they are from the OIF/OEF/OND era. Respondents stated that their participants populations are now younger and have more mental health and severe addiction issues than their previous populations. Additionally, their female population has grown. Respondents were asked, in openended items, what percentage of males and females in their VTCs were charged with certain offense types. Table A 13 displays the results in average percentages for males and females. Regarding offense type differences between the sexes, the most prevalent types of offenses for males were drug (50% average) and DUI/DWI (39% average) offenses, while for females, they were DUI/DWI (49 % average), drug (43% average), and theft/fraud (40% average) offenses. On average, males were i n VTC for more drug, traffic, domestic violence, and weapons charges than females. Female veterans were in VTC for more DUI/DWI, violent (nondomestic), theft/fraud, and prostitution charges than male veterans on average.


86 When reviewing the criminal offenses by sex in Table A 13 it is important to keep in mind that these are the offenses of participants. As seen in Table A 20 numerous VTCs have restrictions on the type of offenses that are eligible for participation. For example, nearly half of VTCs (46% ) exclude all violent felony charges, which may impact the average percentage of domestic violence and nondomestic violent charges seen in Table A 13. Only 1% of VTCs exclude all drug offenses, and drug offenses constitute the highest average percentage of offenses for males and the second highest average percent age of offense type for females. Further, the standard deviations for Tables 8 and 9 indicate that the issues and offenses have a high variability of prevalence across VTCs. Specifically, although t he average percentage of females in VTC with family issues is 54% mental health issues is 59 % and substance abuse issues is 68 % the standard deviation for average percentage of females with family issues is 41 % mental health issues is 40% and substanc e abuse issues is 39% The standard deviations for females were higher than males for all issues faced ( Table A 12) which could because so few females are in VTCs Moving onto Table A 13 the standard deviations for average percentage of females with DUI/ DWI is 45 % for drug offenses is 43% and for violent offenses is 38% Standard deviations for females exceed that of males in every category with the exceptions of domestic violence, traffic, weapons, and prostitution charges. Variability across VTCs is h igh with the exception of females with weapons charges (standard deviation of 1% ), females with traffic c harges (standard deviation of 7% ), females with prostitution charges (standard dev iation of 8% ), and males with weapons c harges (standard deviation of 8% ).


87 VTC Elements In an openended item, respondents were asked to supply the mission state m ents for their VTCs. Tables A 14, A 15, and A 16 delineate the process and impact goals, objectives, and target populations contained in the missions provided by 4 9 respondents, as well as their popularity among the responding VTCs. Impact goals define what changes the program desires to accomplish in the participants or community, while process goals pertain to how the program creators and administrators want the program to operate. Objectives refer to how these goals are to be accomplished (Rossi et al., 2004). Although some of the goals may appear to be objectives, they are goals in the context their respective missions statements and are listed as such. Additionally, some of the more specific items could be combined into general responses but are kept independent to understand the degree of specificity provided by the VTCs in their mission statements. Twelve VTCs reported that they were operating without a specifi ed mission, and 18 did not respond (missing). Impact goals were found in each of the 49 missions provided, but 22% of VTC mission statements did not include a process goal. The reduction of recidivism and creation of law abiding citizens was the most frequently stated impact goal (39% ). Other popular impact goals included promoting or maintaining public safety (31% ), having participants gain productive lives (14% ), and reintegrating participants back into society (12% ). The most popular process goal was to identify veterans in the criminal justice system (leave no veteran behind) with 14% Two VTCs stated that this motto was their entire mission statement. Ten percent had the process goal of providing assistance or service to participants.


88 In evaluation, impact objectives relate to the impact goals, and the process objectives are related to the process goals (Rossie et al., 2004). However, because the objectives were either applied to multiple goals or were ambiguous in their relationship to a particular g oal, the VTC objectives are listed generally (impact or process not specified) with their f requency of mention in Table A 15. Again, although some of the objectives may appear to be goals, they are objectives in the context of their mission statements and are listed as such. Approximately one third of VTCs stated that agency collaboration (35% ) or providing veterans with treatment services/a treatment program (29 % ) were objectives to meet their goal(s). Almost one quarter (24 % ) stated the use of a problem solving court approach either explicitly or by espousing either the use of a court process to address recovery/rehabilitation or linking veterans to treatment as an alternative to incarceration/the traditional criminal justice system to be an objective. Ten percent specifically mentioned providing substance abuse treatment, as well as mental health treatment. Eight percent of the mission statements did not provide an objective. The target populations mentioned in the majority of mission statements were gen eral with 51% holding veterans as their target population, and 22% were slightly more specific in stating that veterans in the criminal justice system were their target population. Other target populations are specified by discharge status, veteran ver sus active duty, charge type, VA eligibility, problem, cause of problem, and relationship of problem to criminal behavior. Mission statements provided were examined to see the degree of diversity in impact and process goals, objectives, and target populati on. A majority did not exist in both goal s and objective categories. The largest percent age of agreement in the


89 mission statement reached 39% in the impact goal of reducing recidivism or creating law abiding citizens (Table A 14). The objective of agency c ollaboration was the item with the second most list ing of 35% (Table A 15). The third most listed item was the impact goal of promoting or maintaining public safety at 31% (Table A 14). The most consensus among VTCs existed in the target populations of the mission statement s. The majority (51% ) listed veterans as the target population (Table A 16), and slightly less than one quarter (24% ) specified veterans in the CJ system. It is logical to conclude that a veteran would not be in VTC if he/she was not charged with an offense, thus being in contact with the criminal justice system. When combining these variables, the majority increases to 75% of VTCs in agreement on the target population. The other 25% widely vary with not more than two VTCs (4 % ) agreeing in any category as they begin to define the offenses, issues, and veteran and military statuses. Table A 17 portrays the trends in the sources of funding and the characteristics of the judiciary, jurisdictions, and mentors, as well as the use of a rewar d/sanction ladder11, while Figure B 5 illustrates the number of VTCs established by year. One third (33 % ) of the VTCs were established in 2011, and slightly more than a quarter (27% ) were established in 2010 (Figure B 5). Table A 17 shows that three quarter s of VTCs (75 % ) have a single judge presiding over their VTC, while one quarter (25% ) have more than one judge. The majority of VTC judges are male (76% ), civilian (55 % ), and preside over another specialty court (63% ). Sixtyone percent of the VTCs have county jurisdiction, and 20% have jurisdiction throughout the state. The majority of VTC programs provide mentors (80% ), 95 % of which are community volunteers, and employ 11 Please note that the sample sizes vary by item due to response rates


90 a reward/sanction ladder (74% ). More than half of VTCs nationwide (53% ) operate solely within the established judicial system, receiving no additional funding. Grants appear to be the most popular funding source (16% have grants as their only additional funding, 9% have grants in addition to other outside funding). Given that the first VTC in Buffalo, New York, strives to be a model for other courts by providing information and training, it is interesting to see where VTCs diverge from the Buffalo model. The first diversion is the veteran status of the VTC judiciary. Judge Russell in Buffalo is a veteran, but nationally, the majority of VTC j udges (55%) are civilian The second diversion is the number of judges that preside over VTCs. Judge Russell is the only judge presiding over the Buffalo VTC. Although 75 % of VTCs have a single judge, one quarter (25 % ) of VTCs did report having more than one judge (Table A 17). Both these diversions from the Buffalo model could affect the relationship participants build with their judges. As stated in Chapter 2, having a single judge is one of the five el ements of a specialized court (Berman and Feinblatt, 2001). The purpose of having one judge is to make sure that a bond is established between the judge and participant with repeated exposure between the two individuals, developing a sense of accountabilit y to the one judicial official. Judges not being veterans could affect the trust level and bonds formed, as well. A case paralleling Cartwrigthts (2011) explanation of veteran perception of civilian treatment providers not understanding the veteran experi ence could be made for having civilian judges instead of veteran judges in VTC. Nineteen percent of VTCs ( Table A 32) reported that the relationship with the judge was one of the most effective components of the VTC, and respondents, although the


91 minority, suggested having veteran preference in VTC staff ( Table A 35) and that civilian VTC personnel were an issue ( Table A 34). Appearing before multiple judges, as well as not fully being understood by or not identifying or connecting with civilian judges, could reduce this bond. A s stated in Chapter 2, research in drug courts has found that the number of judges matter (one judge produces better results); however, drug court research has also found that the length of time participants spent in treatment was a better indicator of rearrest probability than the number of judges seen during the program. The majority of VTCs convene frequently with 47% once a week and 35% two t o three times a month (Table A 26), so frequent exposure to the judge(s) do seem to take place. Although time in treatment was more important than the number of judges, the effect of the bond with the judge on time spent in treatment has not been determined. Additionally, what promotes the creation of a bond between the judge and participant has not been explored to date. One could hypothesize th at the bond with one judge may affect how long a participant remains in the program and treatment. This relationship, how the number of judges in VTC may effect participant compliance and success, and wh at promotes bond creation between the judge and participant should be explored. Judge Russell (2009) listed the use of a system of graduated responses for cooperation and compliance as one of the ten VTC elements (Chapter 2). The majority, 74% (Table A 17 ), employ some type of graduated system of rewards and sanctions (reward/sanction ladder). Russell also listed veteran peer mentors, in addition to treatment and rehabilitation services, as a component of V TCs. Again, as seen in Table A 17, the majority of VTCs have peer mentors (80% ), and all offer mental health and


92 substanc e abuse services (Table A 23). However, only 11% of VTCs require veteran participants to meet with mentors (Table A 23). Various agencies partner with the court system to offer serv ices to veteran participants, and r espondents were asked which treatments and services in their VTC are offered by the VA and by nonVA providers (Table A 18) More mental health, substance abuse, housing, and vocational services are provided through the V A, while nonVA providers offer more educational assistance than the VA. Transportation is nearly evenly provided between VA (61% ) and nonVA providers (62% ). As one would expect, most services are offered by the VA. However, community providers (e.g., f aith based, nonprofit, and private organizations) also provide many services probably because not all veterans are VA eligible, not all services are offered by the VA or every VA facility, or a VA facility may not exist in the area. It should be noted that the mentors are prim arily provided by the community; s pecifically, 95 % are volunteers from the community (Table A 17 ). However, in various qualitative responses, respondents indirectly mentioned that mentors were available through the VA. So the question arises as to why do so few VTCs use VA affiliated or VA provided mentors. One possibility is that it is easier for the VTC to organize and recruit their mentors outside of the VA. VTC respondents reported issues working with the VA; specifically, long wait lists for services, communication and cooperation issues, and availability and accessibility of services were reported as challenges presented by the VA ( Table A 34). Early identification of veterans and quick placement in VTC is another component of VTCs (Russell, 2009; Chapter 2). In a hybrid question, respondents were asked at what stages identification of veterans occurs in their criminal justice system.


93 Respondents were not limited in the number of options they could choose, and they were permitted to add response options that were not already provided. The results not mutually exclusiveare located in Table A 19. The majority of VTCs reported that identification does occur at early phases of the criminal justice process (Table A 19 ), such as at arrest (50 % ), booking (70 % ), arraignment (70% ), and pretrial services interview (62% ). However, approximately half of VTCs (49% ) stated that identification occurs sometime after arraignment. A few VTCs (5% or less) stated that identification has occurred while i ncarcerated, at sentencing, or at a probation violation/revocation review. VTCs appear to be identifying early, but those with late identification should examine why veterans are being identified at the end of the criminal justice process and make adjustments to increase or create early identification efforts In hybrid items with not mutually exclusive response options, respondents were asked what would exclude veterans from participation. Table A 20 displays these results, and the items are grouped into the following categories: military/VA status, criminal, charge (sex, violent, nonviolent, drug, traffic, and miscellaneous/level not specified offences), sentence, and other exclusions. Note, the sample sizes differ by category. Nearly half exclude any violent felony charge from being accepted in their VTC (45 % ) or veterans that have been dishonorably discharged from service (47% ). Approximately one third of VTCs (n=59) do not allow veterans who are ineligible for VA services (32 % ) or who exited service wit h a bad conduct discharge (29% ). More than a quarter (28% ) of VTCs (n=74) do not handle any type of sex offense charge. Additionally, 19% of VTCs (n=74) exclude any type of traffic offense, 18% of VTCs


94 (n=74) do not accept homicide charges, 12% (n=74) do not accept child abuse/sexual assault charges, and 12% of VTCs (n=59) exclude activeduty personnel. Eligibility requ irements appear to vary by VTC, and the reasons for the most popular responses are discussed here. Beginning with the military and VA status exclusions, dishonorably discharged veterans are excluded by nearly half of the VTCs (47 % ), and VA ineligibility or bad conduct discharges follow at 32 % and 29%, respectively (Table A 20 ). Reasons for these high rates of exclusion could include the fact that veterans are not eligible to receive services through the VA if they were dishonorably discharged, and VTCs would then need to offer treatment and services outside the VA. Additionally, the VTC program creators may consider these individuals (i.e., di shonorably discharged, VA ineligible, and bad conduct discharged) too problematic or highrisk non treatable, or to possess less of a response to treatment than those with other discharge statuses. Nearly half of VTCs (46% ) exclude veterans charged with any t ype of violent felony (Table A 20). Sex offenses are also excluded by a higher amount of VTCs; specifically, 28% exclude any type of sex offense with other percentages of VTCs excluding various types of sex offenses or history of sex offender registrat ion. These offense exclusions could be related to the previously mentioned treatability or risk of the offender, as well as mandatory sentences. These exclusions may also be related to program creators want of legitimacy and support from the public, as wel l as political and financial support. In response to a hybrid item with not mutually exclusive response options, respondents reported which individuals screen veterans for VTC eligibility in their VTCs (Table A 21) The eligibility screeners reported by t he highest percentages of VTCs in


95 Table A 21 (i.e., VJO at 55 % VTC coordinator at 51 % prosecuting attorney at 45 % and public defender at 39% ) could be expected for several reasons. Often, this task is in the job description of the VTC coordinator, and t he VJO has access to the VA eligibility of participants. The attorneys must determine whether the charges are eligible, and the prosecuting attorney should be evaluating the level of risk as he/she is supposed to be the proponent for the states interest. Although reported by the minority of VTCs, law enforcement (16% ) and corrections personnel (21% ) seem less logical, and the mechanisms and methods for eligibility screening should be examined by future research. However, it is disturbing that, although minimal, 9% of VTCs use peer mentors and 1% of VTCs use court interns to determine eligibility. One VTC reported that a peer mentor conducts evaluations of the potential participants, which includes a TBI and psychological analysis. Concern arises because training, knowledge, and bias could be problematic with these groups. However, the mechanisms and methods of screening are unknown and need to be examined before any conclusions and problem identification in this area can occur. Resp onding to two hybrid item s without mutually exclusive response options, respondents reported both who it was that had evaluated the veterans issues/needs and what areas of issues/needs are evaluated. The popularity of responses for both the evaluators and the evaluation areas among VTCs is displayed in Table A 22. The majority of VTCs (76 % ) reported that the VJO conducted the initial needs evaluation. Approximately one third of VTCs had the treatment providers, specifically community treatment providers (35% ) or VA treatment provi ders (30% ), conducting the initial needs assessments. Every VTC (100% ) assessed veterans in both the areas of mental health


96 and substance abuse. Nearly every VTC evaluated veterans in the areas of trauma exposure (96% ) and physical health (94% ). Most VTCs also assessed the areas of family relationships (90 % ), social support (90 % ), housing (89% ), employment (87% ), and education (85% ). VTC participation requirements were also requested of the respondent, utilizing a hybrid item without mutually exclusive responses, and the results are depicted in Table A 23. All VTCs (100% ) required that their participants participate in treatment, and 92% required participants to appear frequently in their VTCs. More than three quarters required the participant to sign a contract (81 % ) or regularly check in with someone outside of the VTC team or treatment providers (76% ). The majority of VTCs reported that pleading guilty (61% ) or agreeing to be on probation (56% ) were requirements of VTC participation. The most popular req uirements among VTCs seem plausible when purpose and objectives are taken into account. Treatment is utilized by all VTCs as it is treatment the veterans participate in to address their issues and is often a required in place of incarceration. Constant monitoring and reporting is a VTC component, so frequent court appearances being reported by 92% and frequent reporting by 76% could be anticipated. Because VTC participation is voluntary, the majority of VTCs (81 % ) reporting that a contract is required could also be expected. The respondents perceptions of participant struggles and change were also explored. Difficulty with c ertain program requirements appeared to vary by sex. The major differences occurred for controlling aggression with a fivepoint differ ence (ranked 7 for males and 2 for females), obtaining legal employment with a fivepoint difference (ranked 5 for females and 0 for males), and passing medication screenings with a three-


97 point difference (ranked 9 for females and 6 for males). Although pa ssing drug screens, attending treatment sessions, maintaining housing appear to be issues faced by both sexes, the VTC team and providers should be aware that the sex of the veteran might create more challenges in some areas Future research should try to understand if sex is a causal factor or if there are mediating or spurious elements in action, as well as what may compound or moderate the effect. A deeper understanding of this could provide for an application of more effective treatment regimen earlier on in the program. VTC respondents were asked, in a hybrid item without mutually exclusive response options, about the means of supervision utilized in their VTC. Results are displayed in Table A 24. All VTCs (100 % ) used drug tests, and 97 % of VTCs had s ome type of agency monitoring the participants and reporting back to the VTC. The majority of VTCs also specifically verified treatment attendance (95% ), performed housing dropins (76% ), tested medication levels (65% ), and verified employment (59% ). Nearl y half of VTCs reported specifically checking on curfew (47% ) and utilizing electronic monitoring other than GPS or SCRAM (45% ). One quarter (25% ) of VTCs reported monitoring via GPS. Traditional means of supervision (i.e. drug testing and reporting to an agency such as probation) were reported by all or nearly all VTCs. Although it was reported by 95% of VTCs, I expected 100% of VTCs to verify treatment attendance. However, it appears that drug testing slightly surpasses treatment attendance as the main supervision method. Mentoring appears to be utilized as a means of supervision by very few VTCs, only 3% This could be r elated to the fact that only 11% require participant to meet with mentors, and VTC program creators may want mentors to function solely as resources and support figures and not as supervisors.


98 The 61 VTCs that reported using mentors were asked how they assigned their mentors in a hybrid item, and the response options were not mutually exclusive. VTCs varied in who assigned mentors and what information was used in assignments. As seen in Table A 25, t he majority of VTCs that have a mentoring program appear to have the proper personnel assigning mentors to participants A pproximately half (48% ) had a mentor coordinator assign mentors to veter an participants, and t he VTC coordinator was the next most reported individual in charge of mentor assignment at 18% H owever, t wo responses listed in Table A 25 were unexpected. First, two VTCs ( 3% ) allow the mentors and participants to select one an other Second, the prosecuting attorney assigns mentors in one of VTCs (2%), which is not traditionally a role of the prosecution. Additionally, r espondents were asked how important certain characteristics were when matching mentors to participants ( Figure B 14 ). As one may expect and in seeing the differences in challenges by sex, these individuals being the same sex was ranked as the most important. The next most important was belonging to the same branch. Both of these characteristics may increase bonding and understanding between mentor and participant, as well as allowing for a higher level of trust from the beginning. Future research should explore whether level s of mentor and mentee satisfaction correspond to assignment method s, as well as how the satisfac tion relates to progress, compliance, and graduation of the mentees. Table A 26 displays the results of mutually exclusive hybrid items gathering information on the frequency of VTC sessions and VTC team meetings. Nearly half of the VTCs hold court once a week (47% ), and more than one third (35% ) have court two to three times a month. Similarly, the most popular responses for the frequency of team


99 meetings were also once a week (41% ) and two to three times a month (22% ). Thirteen percent reported that they never meet outside of court but do communicate outside of court, and 3% stated that they never meet or communicate outside of court. As seen in Table A 26, the number of times a VTC team meets generally coincides with how often the VTC holds court. The m ajority of VTC s have court sessions once a week (47% ) and meet once a week (41% ). The second highest reports were holding court two to three times a month (35% ) and meeting this often (22 % ). Although 13% do not meet outside of court, this 13% does communic ate outside of court, which is important. Although the number is small, t here should be some concern with the two VTCs (3%) that never communicate outside of court. For these VTCs, one can only infer that the team updates itself on the various facets of co mpliance during the court session This could pose problems if there are disagreements between VTC team members about compliance or the application of rewards or sanctions. This may not present a united front to the participants and could lower program eff icacy if proper rewards/sanctions are not applied. In a fivepoint scaled item, respondents were asked how often (1 for always 5 for never ) certain individuals were present as participants in VTC. Three other, specify: options were also provided for respondents to indicate other individuals not already listed in the item in an effort to create a comprehensive list of VTC attendees and their frequency of attendance. Seventy four VTCs respondents answered this item, and the results are located in Table A 27. Judges were always present in all VTCs (100% ). The participants were reported to be always present in most VTCs (86% ) and often or never present in 5% and 4% of VTCs, respectively. The prosecuting attorney was reported as

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100 always present in 80% of VTCs; 1% of VTCs reported that the prosecuting attorney never attends VTC sessions. Seventy eight percent of VTCs always have the VJO in attendance, and 74% always have the public defender in attendance. The majority of VTCs always has the probation or DOC offi cer (65 % ), court reporter (61% ), or peer mentors (55% ) in attendance at the VTC session. The treatment provider is always in attendance in nearly a third of VTCs (31% ) and sometimes in attendance in more than one quarter (26% ). Private attorneys are someti mes present in 38 % always present in 24% and rarely present in 19% of VTCs. Other VA personnel are always present in 26% and, conversely, rarely present in 26% of VTC sessions. Twenty three percent of VTCs reported that their coordinator was always present at the VTC sessions. The respondents were asked about the legal and financial benefits they offer to veterans for VTC participation and graduation in a hybrid item The survey did not limit the number of benefits that could be chosen and listed by the respondents; thus, these benefits listed in Table A 28 are not mutually exclusive. All 79 VTCs answered this item. The most reported benefit (92% of VTCs) was diversion from incarceration. The majority of courts drop the charges (77% ) or have the charges reduced (61% ) for participants and graduates. Additionally, 37% withhold adjudication. Even though VTCs are specialized courts, the full 100 % did not report diversion from incarceration as a benefit of participation although the majority (92%) did (Table A 28). This is one of the main goals of specialized courts. With regard to less reported benefits, expunction opportunities are low ( 5% of VTCs), and even if pleading guilty must be required (as it is by the majority of VTCs), including expunction upon grad uation or after several years of no contact w ith the criminal justice system could increase participation.

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101 Graduation requirements were also elicited from the respondents; the respondents were not limited in the number of requirements they chose or wrote in the area provided. All 79 VTCs answered this item; the results are depicted in Table A 29. Nearly all VTCs (99 % ) require participants to complete all treatment requirements for graduation. The majority require the completion of all court mandates (80% ) and probation requirements (66% ). Almost half (47% each) require stable housing or a unanimous agreement among all VTC members that all requirements have been met. More than one third require a treatment evaluation that states improvement (38% ) or a major ity agreement among VTC members that the requirements have been met (37% ). Ten percent of VTCs require 6 months of sobriety for graduation. Regarding the completion of these requirements and the fulfillment of VTCs mandates, the determination of this varies by VTC. More than one third (38% ) require that a treatment evaluation state the veteran has improved from the time of entry. Close to half of VTCs (47% ) required a unanimous agreement among the VTC members, while 37% require a majority decision. Less frequently reportedand unexpected requirements include writing a paper and the belief that the veteran has completed the program after 5 years. Long term research should examine whether there is a relationship between various types of recidivism rates and the graduation requirements prescribed, fulfilled, and unmet. VTC Implementation Issues Regarding presence in VTC sessions, one would expect the usual courtroom players always present (i.e. the judge, prosecuting attorney, and defense attorney ) Accordi ng to the respondents, the judge was always present in all of the VTCs. However, the prosecuting attorney was always present in only 80% of the VTCs and

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102 either sometimes, rarely, or never present in 13% of VTCs. The public defender was always present in only 74 % of the VTCs and either sometimes or rarely present in 15 % of VTCs. No VTC reported the public defender was never present. Even though specialized courts promote a nonadversarial system, it is expected that the courtroom players still be present to advocate, when necessary for their respective parties in this case the state for the prosecuting attorney and the participant for defense counsel. Some respondents did list the lack of presence of the defense attorneys as a challenge ( Table A 34) and sugg ested for the defense attorneys to be present at all VTC sessions and meetings ( Table A 35). Although this absence could be a function of understaffing ( Table A 34), VTCs should not operate without the requisite officials present. In an effort to discern implementation issues, respondents were asked who was required by formal policy to serve as the supervising agents and who served as the supervising agents in practice. Fifty five VTCs responded to this item. The results in Figure B 6 depict who the polic y dictated agents are and whether these agents actually supervised in practice. The program administrator, liaison, case worker, VSO, law enforcement officer, and nonVA mentor that were tasked with supervision fulfilled their roles as supervising agents. The largest discrepancies between policy and practice existed for the private defense attorney with 57% (14 tasked, 6 fulfilled), prosecuting attorney with 31% (29 tasked, 20 fulfilled), social workers with 31% (13 tasked, 9 fulfilled), the VJOs with 29% ( 49 tasked, 35 fulfilled), public defenders with 29% (24 tasked, 17 fulfilled), and probation with 20% (51 tasked, 41 fulfilled) not performing the supervisory roles with which they were tasked. Other groups not completing their supervision duties included 18 % of mentors (17 tasked, 14 fulfilled) and 14% of

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103 treatment providers (28 tasked, 24 fulfilled) not fulfilling their roles as supervising agents. Future research needs to determine which individuals are taking on the role of a supervising agent when the proscribed agent is not fulfilling his/her duty, as well as an understanding of why the agent is not fulfilling his/her duty needs to occur. VTCs should conduct regular performance and implementation evaluations to determine whether, and if so where and why, deviation from policy is occurring. In an openended item, respondents were asked to share any additional information about their peer mentors and peer mentor program. Slightly more than half of VTCs that utilize mentoring responded (31 VTCs, 51% ), and various challenges arose and are listed in Table A 30. At 13 % the most reported issues by respondents were retention and recruitment. Ten percent reported problems with screening and boundary issues (mentors going beyond their roles and acting as counsel ors or law enforcement), screening issues, the program being too new to have mentor roles defined, and mentors keeping in contact with mentees, as well as that mentoring is too time consuming for quality mentors with full time employment. The main issues listed as problems with mentors (i.e., retention and recruitment in Table A 30) could be related to the fact that the majority of mentors are volunteers. It is difficult to fill roles without offering incentives, so these results could be expected. Additio nally, 10% of VTCs reported that the mentor role was too timeconsuming for veterans with full time employment, which could be another reason for low recruitment and retention rates of mentors. A concern does arise from the responses indicating that boundary crossing and role identification issues exist (10% of VTCs), mentoring is occurring in programs that do not havepossibly because they are too new defined

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104 mentor roles (10 % ), and that mentors are not staying in contact with their mentees. Although most respondents felt that the mentoring component of their program was effective or very effective almost 20% of respondents felt this component was neither effective nor ineffective ( Figure B 15). The VTC or components o f VTCs should not be operating without clearly defined roles and procedures and proper training of all personnel. Operating in this manner can lead to unintended consequences. However, other recommendations cannot be supplied at this time because the relationship between these three issues and their causes need to be explored. In an effort to understand the actions and interactions between the VTC team members amongst themselves and between the VTC team members and the agencies they partner with, several items asked using a fivepoint Likert s cale ( never, almost never, sometimes, almost always, always ). The first item assessed how often they felt their team members: 1. Believed in the same mission 2. Cooperated with each other 3. Effectively communicated with each other 4. Effectively listened to each other 5. Deviated from their set roles 6. Did not follow procedure The second item assessed how often they felt the agencies they worked with: 1. Believed in the same mission 2. Cooperated with the VTC 3. Effectively communicated with the VTC 4. Deviated from their set roles 5. Did not follow procedure Figure B 7 illustrates the responses of 73 VTCs on their feelings of their team members, and Figure B 8 depicts 72 VTCs responses for feelings on their partner agencies. Almost half of VTCs feel that their team members always ( 47 % ) or almost always (48 % )

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105 believed in the same mission. The majority of VTCs also felt that the agencies they work with at least almost always believe in their mission ( almost always at 59 % always at 29% ). Although, 10% of VTCs reported that their partn ering agencies sometimes believe in their mission. The majority of VTCs feel that their team members are frequently cooperative (59% always 47 % almost always ), as well as their collaborating agencies ( always at 37% almost always 57 % ). The majority of VTC s feel that their team members at least almost always effectively communicate with each other ( almost always at 57% always 36% ). The majority of VTCs felt the similarly about the effective communication with the agencies they work with ( almost always at 6 4 % always at 22% ); however, 14% of VTCs felt the agencies sometimes communicate effectively with their VTC. Effective listening occurs always (37 % ) or almost always (55 % ) between the majority of VTC members. The majority of respondents felt that team memb ers at least almost never deviated from their roles ( never at 25 % almost never at 38 % ), and one third felt that team members sometimes deviated from their set roles (33% ). The majority of VTC respondents felt that the agencies at least almost never deviat ed from their set roles ( never 36 % almost never 17% ), while 18% felts that the agencies sometimes deviate from those roles. The majority of respondents felt that team members followed procedure at least most of the time (48% never deviated and 41% almost never deviated from procedure); 10% felt their team members sometimes did not follow procedure. Similarly, more than three quarters of VTCs reported that their collaborating agencies either never (40 % ) or almost never (44 % ) deviated from procedure, and 14% of VTCs reported their agencies sometimes deviated from procedure.

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106 Overall, positive interaction between, adherence to procedure by and belief in the same goal by VTC team members were occurring in the majority of VTCs always almost always or sometime s (Figure B 7). Additionally, the interactions between the VTC and agencies generally appear to be positive and effective. These circumstances aid in proper implementation of the program. Although it may be difficult due to understaffing, internal anonymous surveys should be administered to VTC team members to understand whether their VTC is struggling in any of these areas, and if so, what specifically the problems are. P roper training and screening and frequent retraining may be able to address the issues discovered. Perceptions of Participants How VTC personnel view the participants and the roots of their problems can impact the way they treat the participants, so perceptions of the causal relationship of their problems and the participants themselves we re also examined. Because the VTC is based on the belief that military service results in various issues (e.g., mental health, substance abuse, and homelessness) which then cause contact with the criminal justice system, respondents were asked the following three questions in an effort to determine whether they themselves believed in these relationships: 1. Generally, do you feel that the veteran participants military experiences caused the issues that they are now experiencing (mental health, substance abus e, homelessness, etc.)? 2. Generally do you feel that the veteran participants' issues they are now experiencing (mental health, substance abuse, violence, homelessness, etc.) caused their legal problems (arrest)? 3. Generally do you feel that veteran participants' military service caused the issues they are now experiencing (mental health, substance abuse, violence, homelessness, etc.), which in turn caused their legal charges?

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107 For each item, the respondents were provided with five response options (Likert scale): definitely yes, probably yes, maybe, probably not, definitely not Figures B 9, B 10, and B 11 display these results. Less than one quarter (21%) of the 71 respondents thought that relationship between military experience and personal issues definitel y existed, and almost half (49%) believed the relationship probably existed (Figure B 9). More than one quarter (28%) thought that this relationship might ( maybe) exist. Similarly, more than one half of the 71 respondents (48%) believed that the issues the veterans were facing probably contributed to their contact with the criminal justice, and less than one quarter (17%) thought this relationship might ( maybe) exist. However, more than one third (34%) definitely believed there was a relationship connection (Figure B 10). One percent of the 71 respondents did not believe in either of these relationships (Figures 8.1 and 82). Figure B 11 illustrates the strength of belief in the relationship between military experience, issues, and contact with the criminal justice system. Again, half of the 70 respondents (50%) believe this relationship probably exists. However, nearly one quarter (24%) are unsure of this relationship ( maybe), while almost another quarter (23%) definitely believe this connection exists. Three percent said military experience and personal issues were probably related to the criminal justice contact. Across the Figures B 9, B 10, and B 11, the most popular response is a probably yes, meaning that the respondents believe that there is most likely a relationship between these issues. The fluctuation is minimal when discussing the three different relationships ( 1% differences between tables). More fluctuation exists for other levels of belief across depending upon the relationship examined. A very small minority (ranging from 1% to 3% ) of respondents believed these three relationships probably do not or

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108 definitely do not exist, while t he majority believe these relationships definitely or probably exist. Further, the majority of respondents believe the veteran participants do change because they have completed the program (Table 10). This is important when thinking about implementation. W hen individuals do not believe in the existence of an issue or a policy or do not believe the program achieves the intended impact or impact desired by the individual they are more likely to deviate from procedure and act according to their personal beliefs. The reasons behind whether personnel believe in these relationships should be explored, and this can be done w ith the data collected from the survey. Other research, beyond the scope of this survey, should examine whether the varying beliefs affect implementation of the program. Respondents were asked to rank the level of difficulty males and females had with cer tain program requirements (9 for most difficult, 0 for least difficult). The results (average difficulty rank) of 36 respondents are displayed in Figure B 12. Respondents felt that the most difficult requirement for both males and females to comply with was passing the drug screens. Aside from the requirement ranked as the most difficult on average, difficulty levels vary by sex. Respondents felt the next five most difficult requirements on average for males, ranging from most to least difficult, were attending treatment sessions (level 9), maintaining steady housing (level 8), controlling aggression (level 7), passing medication level testing (level 6), following housing facility rules (level 5), and reconciling with family (level 4). Respondents felt the next five most difficult requirements on average for females, ranging from most to least difficult, were passing medication level testing (level 9), attending treatment sessions (level 8), maintaining steady housing (level 7), complying with housing facilit y rules (level 6),

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109 obtaining legal employment (level 5), and ceasing to use illegal means to gain income (level 4). The four least difficult requirements perceived by the respondents on average for males were ceasing the use of means to gain income (level 3), complying with probation requirements other than those listed (level 2), having access to transportation to comply with requirements (level 1), and obtaining legal employment (level 0). For females, respondents perceived the least four difficult requir ements on average to be reconciling with family (level 3), controlling aggression (level 2), complying with other probation requirements not listed (level 1), and having access to transportation to allow them to complete requirements (level 0). Respondent s were asked, on a fivepoint Likert scale ( never, almost never, sometimes, almost always, always ), how often they felt their veteran participants: T ried to comply with court mandates Were grateful for the opportunity provided by VTC Did not want to partic ipate Thought their issues were related to military service Had changed because of program completion The results of 72 respondents are illustrated in Figure B 13. The majority of respondents (85% ) felt that the veteran participants almost always try to c omply with the court mandates and that the veterans are at least almost always grateful for the opportunities provided by their VTC ( always 22 % almost always 63% ). More than half (54 % ) perceived that their participants almost never want to participate (i. e., participants are perceived as almost always wanting to participate), and one third (33% ) reported perceiving that their veterans sometimes do not want to participate. Slightly more than half of respondents (52 % ) believed that their veterans thought their issues stemmed from their military service, and more than one third (38% ) perceived the participants

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110 almost always made this connection. The majority of respondents felt their participants always (21 % ) or almost always (61 % ) changed due to program compl etion, while 14% felt their participants sometimes change because of program completion. Overall, the majority of respondents felt that veterans want to engage in the program requirements at least almost always are almost always grateful for the opportunities provided by the VTCs, and almost always comply wi th the court mandates A positive view of and support for participants is important to promote growth of participants toward the goals, and the veteran knowing the VTC team wants them to succeed/takes the time for them to succeed was the third most reportedin an openended item effective component of the VTC program (22% of VTCs). In an openended item, respondents were asked to list the changes they have seen in their participants during their VTC participation. The responses of 62 VTCs are depicted in Table A 31. Nearly one third (32% ) of VTCs reported a decrease or cease in substance use. Almost one quarter (24% ) reported seeing an increase in pride, self esteem, or integrity within participants, and 21 % perceived participants gaining hope and becoming more positive about their futures. Slightly less than one fifth of respondents noticed veterans improving their relationships with family (18% ), obtaining steady employment (16% ), or reintegrating wi th their community (16% ). Fifteen percent noticed improvements in mental health (i.e., decrease in mental health symptoms/issues and less anxiety or stress). More than 10% perceived an increase in responsibility (13% ) and in understanding themselves or the causes of their behavior (11 % ).

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111 Most intra participant changes were expected and related to one another. However, one VTC reported that participants, after participating in the program for some time would begin to admonish noncompliant participants an in teresting inter participant change and increase in social control within the program. The most reported effective components reported ( Table A 32 ) could, again, be anticipated (e.g., counseling/treatment, mentoring, having the team want them to succeed, support of fellow veterans, accountability, relationship with judge, nonadversarial approach). Having VTC members that were veterans was, however, reported as an effective component by only one respondent. In light of the previous discussion bonding, this l ow percentage ( 1% ) was somewhat surprising. However, the highly reported item of camaraderie and understanding of fellow veterans/peer support could be accounting for this, and 4% of VTCs reported that having civilian VTC team members was an ineffective practice. Continuing discussion of ineffective components, treatment/counseling services offered by the VA were deemed ineffective by 18% of respondents. Reasons for this could be included in the challenges listed ( Table A 34 ), such as long wait lists for VA services, bureaucratic inefficiency, or the VA not having the resources needed. Perceptions of VTCs Respondents were also asked several questions about their perceptions of the VTCs themselves. R egarding mentoring, r espondents were asked to assign level s of importance to various mentor characteristics that could be used to help assign mentors to participants (0 being not important at all, 10 being extremely important). Figure B 14 illustrates the average levels of importance from 55 respondents. Because the standard deviations were large, they are also included on the graph. The mentor being the same

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112 sex as the participant received the highest average level of importance (average of 8). The next most important characteristic on average was the mentor serv ing in the same military branch as the participant (average of 6). Similarity in age between mentors and participants and mentors having trauma experience were somewhat important (each averaged level 5). Respondents were asked how effective they felt the treatment and mentoring offered by their VTC was, as well as how effective they believed their VTC was in achieving its mission. A five point Likert scale was used ( very ineffective, ineffective, neither ineffective or effective, effective, very ineffecti ve ), and the 70 respondents results are illustrated in Figure B 15. Overall, the majority of respondents believed their treatments, mentoring, and programs were at least effective. The majority of respondents (53% ) felt that the treatment provided was effective and 41% felt that the treatments offered were very effective Forty percent and 35% of respondents felt their VTCs mentoring was effective and very effective respectively. More than half of respondents (54% ) believed their VTC was effective in ac complishing its goals, and 42% believed their VTC was very effective in its goal accomplishment. Respondents were ask ed, on a fivepoint Likert scale ( always, almost always, sometimes, almost never, never ), how often they felt that their VTC achieved its mission, positively impacted veterans, negatively impacted veterans, and did not impact veterans. Figure B 16 illustrates the results of 72 respondents. More than three quarters (78 % ) of respondents felt their VTC almost always achieved its mission. Approx imately two thirds (67% ) felt that it almost always positively impacted veteran participants, and 25% felt that it always made a positive impact. More than half (56% ) felt that it almost

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113 never negatively impacted veterans, and 33% felt it never resulted in a negative impact. Ten percent perceived that their VTC sometimes negatively impacted veterans. Respondents were asked, in an openended item, what were the most effective components or elements of the VTC in causing positive change in veteran participa nts. All 79 VTCs responded, and the results are located in Table A 32. Almost one third of VTC respondents (30 % ) felt that counseling or treatment was the most effective component for positive change in veteran participants. Nearly one quarter (24% ) stated mentoring was effective, and 22% reported that the veteran knowing the VTC team wanted them to succeed or knowing the VTC took the time for them to succeed was effective. Nineteen percent stated that the camaraderie, understanding, and support from the ot her veterans was influential, and 18% stated that holding veterans accountable (sanction application) and the relationship with the judge were effective for change. Fourteen percent of respondents reported the use of the nonadversarial team approach was e ffective. Conversely, respondents were asked what components were ineffective in their VTC. Most did not report any ineffective components, but the results provided by 55 respondents are listed in Table A 33. Eighteen percent stated that the VA treatment services were ineffective. Four percent of the respondents stated that having civilian VTC team members; operating with unclear expectations, no policies, or no procedures in place; and not immediately applying rewards and sanctions were ineffective compon ents or ways of operation. Respondents were also asked in an openended question what challenges their VTC faced. Table A 34 depicts the responses of all 79 VTCs. One quarter (25% ) of

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114 respondents stated that funding was an issue. Eighteen percent reported long wait lists for and delay to access VA services were a challenge, and 15% of VTCs held that being understaffed was a difficulty. In an openended question, respondents were asked what they would change about their VTC. Fifty eight respondents provided responses and these results are located in Table A 35. At 14 % the most frequently suggested change was to increase funding, generally. Ten percent of respondents would like to improve the relationship between the VA and their VTC, and 9% suggested incr easing their VTC staff. Offering better sentencing options, increasing housing services, generally having more resources, and implementing a mentor program were each suggested by 7 % of the responding VTCs. National Survey Limitations With these types of s urveys, despite multiple reminders, many possible part icipants do not respond. Table A 42 displays the response rates to the national survey. Because the entire population was contacted to participate and the only information known about the nonparticipant s is their locations, the non response bias was difficult to address; however, I statistically explored these differences. A contingency table of nonresponse rates and regions ( Table A 43) was created. Then, an oneway ANOVA was employed to determine whet her nonresponse rates (dependent ratio variable) of the four regions (independent categorical variable) were significantly different; the difference between the nonresponse rate means between the four regions was not significant (p=.132). Tables 22 1 an d 222 show response rates for the Northeast and the South were similar and that the West and the Midwest had similar response rates. Therefore, I

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115 created a new tworegion variable consisting of the East (collapsing Northeast and South) and West (collapsing West and Midwest). Once collapsed, the nonresponse rates were 42% for the East and 21% for the West (Table A 44). The oneway ANOVA was rerun to determine whether nonresponse rate means between the East and the West regional groups were statistically s ignificant. This time, the difference was statistically significant (p=.016). Using data from the nonparticipant VTCs, these results indicate that group membership to either the East or West region is related to not responding to the survey. Specifically, VTCs in the East were more likely to not participate in the survey than VTCs in the West. Reasons for this are unknown12, 13. Several limitations apply to the national survey results. These VTCs are new and m ay not be set in their ways and constantly chang ing (Chapter 5) The size of the VTC participant populations and current caseloads were not included in the cluster analysis because they are highly related to the age of the VTCs. The actual sizes of the jurisdictions are unknown and, thus, could not be i ncluded. Average percentages reported in the national survey results should be read along with the standard deviations presented. Some standard deviations are quite large, indicating large variation across VTCs nationally. 12 A suspect reason was population. The populations in these regions, according to the 2010 census, range from approximately 55.3 million to 114.5 million. However, this relationship does not appear to exist. Although the Midwest has the largest amount of VTCs with 32, the Midwest had the third largest population out of the four regions. The South, according to the 2010 census, had the largest population with approximately 114.5 million, but the Sout h had the least amount of VTC within its region at 25. However the frequency of existence of VTCs within a state, again, do not correspond with population. For example, while the 2011 population for California is the largest of the states (more than 37.6 m illion), California is not the state with the most VTCs but is tied for third with nine. 13 Because a geographical dimension exists in the data, I explored whether geography was related to certain characteristics reported in the national survey (i.e., fun ding, number of judges, and eligibility requirements). However, crosstabulations and correlations did not reveal any significant relationships.

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116 For the comparisons between the veteran population and the VTC participants, it is important to note that data from each group were matched as closely as possible. The most recent data for the veteran population is from 2009 and 2010, while the VTC participant information is more current from 2012. Specifically regarding the comparison of the age variables the age ranges for the VTC participants start one year later and goes one year longer than the veteran population age ranges. Although ineffective components were asked about, the sur vey did not specifically cover unintended consequences. While the majority of respondents feel their VTC at least almost always positively impacts veterans and at least almost never negatively impacts veterans, some respondents did feel that their VTC some times negatively impacts veterans (10%) and felt there has been no impact on veterans (10%) ( Figure B 16). Unintended consequences, as well as lack of impact, should be further examined in an effort to improve impact and achieve higher rates of goal attainment. National Survey Conclusion Questions arise as to why these specialized courts have emerged in specific states and whether VTCS diffusing in a similar pattern as drug courts and mental health court s. VTCs have rapidly spread nationally; specifically, 114 VTCs emerged between January of 2008 and October 2012 across 32 states. However, they do not exist in every state, and there is a group of states in the middle of the country where none currently exist nor are any planned: North Dakota, South Dakota, N ebraska, Kansas, Iowa, and Wyoming (Figure B 4). The geographic diffusion of drug courts has not been visually tracked to date, and the oldest map of drug court locations available contains geographic data up to 2009. As of July 2009, more than 2,500 drug courts were in operation and located in every state (47% of U.S. counties), the District of Columbia,

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117 Puerto Rico, Guam, Northern Mariana Islands, and 90 Tribal locations in the United States (ONDCP, 2011) (Figure B 24)14. Although the drug court map covers a span of 20 years (1989 to 2009), states that appear sparsely populated with drug courts include North Dakota, South Dak ota, Kansas, Wyoming, and Nevada. This list is similar to the VTC list of states without any VTCs. However, major differences between the two maps can be seen for Louisiana and Kentucky where VTCs do not exist but drug courts have a heavy presence. VTCs may diffuse more rapidly and more evenly because of the distribution of veterans in the population. However, only time will allow for an adequate geographic comparison, but the comparison should be explored This study is the first national sys tematic national survey of VTCs and therefore, is the first opportunity to explore whether the structure and the intent of VTCs nationally are consistent of with Russells (2009) ten tenets of VTCs. These components, listed below are assumed to generally serve as guidelines for VTCs. 1. Integration of alcohol, drug treatment, and mental health services with justice system case processing 2. Non adversar ial approach 3. Early identification of eligible participants and prompt placement in the VTC 4. Access to a continuum of treatment and rehabilitation services in addition to veteran peer mentors 5. Alcohol and drug test monitoring 6. System of graduated responses for cooperation and noncompliance 7. Continual judicial interaction with the veteran offender 8. Monitoring and evaluation of programs 14 The most recent drug court map illustrates the location of 2,644 drug courts national as of December 31, 2011 (National Drug Court Institute, 2011).

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118 9. Educational interdisciplinary training of all involved in VTC (criminal justice and treatment parties) 10. Forging partnerships among the Veterans Treatment Court, the VA, public agencies, and community based organizations generates local support and enhances the Veterans Treatment Court's effectiveness ( p. 367) From this survey, we get a national picture of VTCs that is, in concept a nd intention, ve ry much congruent with this generally accepted set of standards All VTCs offer some type of substance abuse treatment and/or mental health treatment in conjunction with their case being processed through VTC (component 1), as well as moni toring methods (component 5). The majority (92%) require frequent VTC appearances, which facilitate continual judicial interaction (component 7), and 74% employ a reward/sanction ladder (component 6). Component 4 addresses access to both a continuum of s ervices and peer mentors. All VTCs offer a combination of mental health and substance abuse services, and 80% offer peer mentors. However, few (11% of those VTCs with peer mentors) actually require participants to have mentors. Early identification (component 3) can happen in the majority of VTCs: 46% at arrest, 70% at booking, 62% at pretrial services interview, and 71% at arraignment (Table A 19). However, as previously discussed, nearly half of VTCs also reported that veterans are identified at some st age of case processing after arraignment. Component 3 appears to be something that VTCs still need to cement into their VTC system and process. Regarding component 10, VTCs partner with numerous agencies and have good relationships overall with these agenc ies (Figure B 8). However, several VTCs reported strained relationships with the VA. VTCs reported communication issues (Tables 16 and 17), long wait lists for services (Table A 34), and lack of services (Table

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119 A 34). Recommendations to ease this tension are provided later in this section, as well as previously discussed (National Survey Discussion and Implications section). Several components were not specifically addressed in the survey, but responses allow for some discussion of the presence of these co mponents nationally. Regarding a nonadversarial approach (component 2), respondents were not specifically asked whether their VTC employed a nonadversarial approach. However, this component was mentioned in responses to several openended items. Fourteen percent included it as an effective component of their VTC (Table A 32), and 8% had it as a process goal in their mission statement (Table A 14). Few reported in that it was something their VTC needed to work toward. Specifically, 3% reported the prosecut ing attorneys office was unsupportive (Table A 34), and 2% suggested that their VTC team become more nonadversarial (Table A 35). VTC and treatment team training (component 9) was not directly addressed in the survey; however, training did appear in open ended items regarding VTC challenges (Table A 34), problems with peer mentors (Table A 30), and suggested changes (i.e., to have mandatory training of VTC personnel) (Table A 35). Component 8 is ambiguous with regard to who should be conducting the mo nitoring and evaluation of [VTC] programs. Results from my survey show that 73% of VTCs track their outcomes and progress. Monitoring and evaluation by external agencies was not addressed in the survey, but 1% of VTCs reported that lack of state oversight was a challenge facing their VTC (Table A 34). The national survey also reveals some challenges facing VTCs (Table A 34) as they seek to meet the standards they have set for themselves, and respondents were

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120 asked how they would improve their VTCs. Whil e many of these responses were anticipated (e.g., increase funding, personnel, resources), others were not initially. VTCs (10%) suggested an improved relationship, specifically communication and cooperation, between the VA and the VTC. Upon VTC start up, personnel and agencies should meet to discuss expectations and resources and to determine roles and protocol. Future endeavors should see if these issues are arising from an absence of this initial collaboration and communication or if it something endemic of the agency itself. As seen in the responses to the national survey, both trends and variability have been seen in VTC funding, structure, operation, and eligibility and participation requirements. However, the results from the national survey simply r eport trends in VTCs per item. This research only looks at trends of specific items across courts nationally, which lays the groundwork for future research I plan to conduct utilizing these data. The results currently do not examine relationships within an d between items (e.g., whether the responses overlap within t he not mutually exclusive items and whether there are correlations between items suck as eligibility requirements and participant demographics) An examination of the existence of these items wi thin courts should be undertaken with the goal of determining whether types or categories of VTCs exist whether VTC models exist. To date, this type of categorization has not been conducted for any type of specialized court. The following sections builds o n the results of the national survey and takes this next steps toward determining whether any VTC model or models are currently in existence.

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121 VTC Typology As previously explained, twostep cluster analysis was employed for the exploration of a VTC typology. The variables utilized are explained in the first subsection, and the second subsection reviews the results. This section concludes with the Discussion and Implications subsection. Typology Variables Upon examination of the national survey results (s pecifically looking for variance in responses) and thinking about the literatur e, I conceptualized three areas/ groups of variables: 1) structure/staff/resources 2) role of treatment providers 3) eligibility (target population). Variables within these groups were created in various ways and were all explored in the analysis. Staffing, structure, and resources I wanted to explore whether VTCs were either well funded programs offering a variety of services or struggling ventures. Items that could lend to identification of a VTC as well funded or struggling include sources of funding, total number of treatments and services available, total number of supervising agents, total number of means of supervision, total number of judges, and jurisdiction. Funding. Several funding variables were created. One ordinal variable (Fund1) was created to indicate the levels of funding with the knowledge of funding amounts available at difference levels. The coding was comprised of 0 for no additional funding; 1 for county, local, or local nonprofit funding; 2 for state funding; 3 for federal funding; 4 for federal and county, local, or local nonprofit funding; and 5 for federal and state funding. A second funding variable (Fund2) was also created by collapsing Fund1 into a

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122 dichotomous variable where 0 indicated no additional funding and 1 indicted additional funding. Number of Treatments/Services. Several types of treatment/services available variables were created. For the first group of variables, a count variable for eac h type of VA or non VA provided treatment or service (mental health, substance abuse, housing, transportation, mentoring, vocational, education, VA benefit assistance, home goods/furnishings, and medical) were created. Because so few VTCs specifically reported offering education, VA benefit, home goods/furnishings, and medical assistance, these count variables were combined into a single other service count variable. For the second group of variables, each count variable was collapsed into dichotomous variables for each service (mental health, substance abuse, housing, transportation, vocational, mentor, and other) where 0 indicated the VTC did not offer this service and 1 indicated that it did. For the third variable, these dichotomous variables were summed into a single count variable to indicate the total number of service types offered. Number of Supervising Agents. Two count variables were created for supervising agent numbers. The first was created by summing all dichotomous variables for supervising ag ents defined by policy, and the second was created by summing all dichotomous variables for supervising agents in practice. Number of Supervision Means A count variable was created by summing all the dichotomous variables for means of supervision reporte d. Highest Jurisdiction An ordinal variable was created from the jurisdiction information provided by the respondents. Because several VTCs operate a several

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123 jurisdiction levels, the highest level was taken to create this ordinal variable. This variable was created because more funds and resources may be accessible to courts with higher jurisdictions levels (e.g., federal courts may have more resources than municipal courts). For this variable, 1 represented city/municipal/town, 2 for county, 3 for state, and 4 for federal. Number of Judges. Two variables were created. The first was a count variable. The second was a dichotomous variablebecause the original VTC, as well as 75% of VTCs, had a single judgewhere 0 equaled one judge and 1 equaled more than one judge. Role of treatment providers: therapeuticcentered versus management centered Although VTCs fall under the umbrella of specialized courts, the role of treatment may vary across VTCs. In Poor Discipline, Simon (1993) discusses how the progression of technology has provided for the creation of new surveillance mechanisms, which allows institutions to predict behavior and classify offenders (risk and need scores), track and monitor compliance, and test of substance use. These means of supervision a nd evaluation can be used as more of a management tool rather than a therapeutic one. Here, I wanted to examine whether certain VTCs were more management or therapeutic centered. I conceptualized this as therapeutic oriented VTCs should have treatment providers in gatekeeping roles and apply weight to subjective assessments, while management oriented VTCs should focus on traditional, criminal justice means of evaluation and supervision. Numerous variables were used to operationalize these categories, speci fically number of types of supervision means, number of types of supervising agents, number of evaluation areas, participation requirements, and veteran status of judges.

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124 Number of types of supervision means Two ratio variables were created in the follow ing steps First, I summed the dichotomous supervisions means variables related to treatment; the dichotomous variables indicating whether a court employed medication level screening, treatment verification, and mentoring were combined into a count variabl e to indicated the number of means utilized to supervise participation in or adherence to treatment. Then, t his count variable was then converted to a ratio to indicate the percentage of possible therapeutic supervision means being utilized by the VTC. The second ratio variable accounts for percentage of means of supervision that are often used for offender management not therapeutically related. First, t he dichotomous variables indicating whether a VTC employed electronic monitoring, GPS monitoring, report ing to an agency for check in, curfew checking, and housing dropins were summed to create a count variable for means of super vision relating to management. Then, t his count variable was then converted into a ratio variable to indicate the percentage of ma nagement supervision means that were used by the VTC out of all possible management supervision means. Ratio variables were created because the number of possible means for each category of supervision means differed. Note, the means of supervision related to substance use (i.e., drug screens, SCRAM bracelets, and ignition interlock) were not included in either of these variables because these means of supervision are often utilized for both therapeutic and management ends and were too difficult to solely place into one of these categories because information on how these means were used by the VTC were not available. Number of types of supervising agents Two count variables were created for numbers of supervising agent types. First, supervising agents per policy and in practice

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125 were each categorized into groups of either therapeutic agents (per policy, in practice) or management agents (per policy, in practice). Therapeutic agents for policy and practice consisted of treatment providers, mentors, VJO, VSO, and other VA personnel. Supervising agents for policy and practice were comprised of the traditional supervising agents in the criminal justice system, the prosecuting attorney, public defender, and probation officer. For the therapeutic agents, because t he VJO, VSO, and other VA personnel appear to function in similar capacities, these dichotomous variables were collapsed into a single VA connected dichotomous variable for policy and for practice. VA mentors as supervising agents and volunteer mentors as supervising agents were also collapsed into a single dichotomous variable for both policy and practice. Each group of therapeutic agents (i.e, policy and practice), were then each combined into count variables, resulting in count variables for number of therapeutic agents per policy and therapeutic agents in practice. For the management agents, these dichotomous variables for prosecuting attorney, public defender, and probation officer were combined into count variables for each policy and in practice group, resulting in count variables for number of management agents per policy and management agents in practice. All count variables remained as such, not converted to ratio variables, because the number of personnel in each group were equal (three). Number of types of evaluation areas. A count variable was created for therapeutic evaluation areas. Therapeutic evaluation areas included mental health, substance abuse, housing, trauma exposure, family relationships, social support, education, employment, transportation, benefits, and gambling addictions. Each

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126 evaluation categorys respective dichotomous variables were combined to create a count variable for number of therapeutic evaluations. Participation requirements Participation requirements were categorized as either a management requirement or a therapeutic requirement. Participation requirements included pleading guilty, going on probation, and living within the jurisdiction, while therapeutic requirements included agreeing to participate in treatment, freq uently appearing in court, and meeting with mentors15. These dichotomous variables were then collapsed into their respective categories, creating count variables for management requirements and therapeutic requirements. Count variables were not converted to ratio variables because the numbers of requirements in each category were equal (three). Eligibility requirements: creamers versus all purpose Eligibility and target populations are imperative areas of examination when interpreting results of any type of program and must be excluded here. Because of the large variance in eligibility requirements (and exclusions), I wanted to explore whether some VTCs are creaming (i.e., allowing only the lowest risk offenders or individuals with the highest predicted s uccess rates to participate) or are more all purpose in their approach, meaning that they strive to target as many veterans with problems as possible. Items that may provide information on these categories include veteran status exclusions and charge exclusions. Veteran status exclusions. Two veteran status exclusion variables were created, one count and one dichotomous. The first variable is a count variable, created 15 Substance testing was excluded here for the same reasons previously discussed under means of supervision.

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127 by summing the types of veterans exclusions (dichotomous variables of bad conduct dischar ge, dishonorable discharge, other than honorable discharge, VA healthcare ineligibility, and active duty status). The second variable is a dichotomous variable, created by transforming the previously created count variable so values above zero would be com e 1 (to indicate that a veteran status exclusion existed) and the 0 values would remain as 0 (to indicate that no veteran status exclusion was used). Charge exclusions Two charge exclusion variables were created. The first variable is a dichotomous variable indicating whether a VTC excludes all violent felony charges (1 for yes, 0 for no). The second variable is a dichotomous variable indicating whether a VTC excludes all felony charges, (1 for yes if the VTC excludes both violent and nonviolent felony charges, 0 for no if it does not do so). Typology Results and Discussion In an effort to obtain a more manageable set of variables within each of the three variable groups (staff/structure, role of treatment providers, and eligibility) and to see whether clusters existed within these groups (i.e., well funded versus struggling start up, therapeutic versus management, and creamer versus all purpose), clustering within variable groups was conducted first. BIC was used to determine the amount of clusters (Analyt ic Plan) and the critical line test was used to determine which variables distinguished between clusters (Analytic Plan) Once variables within each group were narrowed, the full model containing the resulting variables was run, as well as a subsequent mo del. The results are presented and discussed in this subsection. For the clustering of all defined staff/structure variables, the dichotomous funding and judge variables were resulted in more distinct clusters than the ordinal funding and the count judge v ariables, and outlier handling did not change the results. Model 1 uses

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128 all staff/structure variables (the dichotomous judge and funding variables) without outlier handling. Four clusters emerged, and no cases were excluded. Results are depicted in Table A 36. Cluster 1 has VTCs with one judge and most VTCs at the city/municipal and state levels. Cluster 2 is comprised of VTCs with more than one judge. Cluster 3 consists of VTCs with external funding, Cluster 4 has VTCs without external funding at the count y level. To further explore the groupings of staff/structure variables, subsequent models were run. First, the total number of supervising agents per policy were excluded because those means were the same a total number of supervision means; however, this model did not differ from Model 1. Second, the supervising means and agents in practice were removed, which, again, did not change Model 1. Finally, the total number of services available was also removed, resulting in only the significant variables from Model 1 being included. Results for Model 1b are located in Table A 37. In addition to cluster size, the only change from Model 1 to Model 1b is that the number of judges also became an important variable for Cluster 4. Clusters defined by funding (3 and 4) and clusters defined by structure/staff (1, 2, and 4) appear to have emerged. Across clusters, external funding does not appear to be related to the number of judges or the jurisdiction level. Regardless, because of their importance in cluster different iation across both Models 1 and 1b, funding, number of judges, and jurisdiction level variables were included in the full model ( Model 4). Because all the treatment provider variables were continuous, hierarchical clustering using Wards method and the sq uared Euclidian distance measure16 was 16 These are the standard methods and measures utilized for continuous data in hierarchical clustering.

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129 used (Model 2). Figure B 20 depicts the dendogram, which indicates that there are two main clusters and one minor cluster. The analysis was then rerun with three clusters indicated, and a variable assigning each case t o a cluster was generated and saved. The number of VTCs belonging to each case are included in Table A 38. Clusters 1 and 3 were the main clusters with 30 and 38 VTCs, respectively, while Cluster 2 was the minor cluster with only 11 VTCs. Oneway ANOVAs we re then conducted to determine the means and frequencies of the clusters and whether these classifying variables were important. According to the ANOVA, cluster and total differences were significant for both the percentage of management and treatment supervision means, as well as for the total number of management participation requirements and therapeutic evaluations offered. The Tukey post hoc test was employed to see which variables were important to the creation of specific clusters, and these results are included in Table A 38 Management supervision means were highly significantly different between Clusters 1 and 2 and between Clusters 1 and 3. Treatment supervision means were highly significantly between Clusters 1 and 2. Management participation req uirements were highly significantly different between all three clusters. Therapeutic evaluations were highly significantly different between Clusters 1 and 2 and between Clusters 1 and 3. Although the ideas of therapeutic oriented and management oriented courts was previously presented, Cluster 1 has more therapeutic and management tools and requirements overall. Clusters 2 and 3 do not clearly belong to either category. These results seem to indicate that the clusters vary on resources (means and types of evaluations) and requirements more than the proposed orientations (therapeutic and management). However, because of their importance, the management and treatment

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130 supervision means, therapeutic evaluations, and management participation requirements were i ncluded in the full model (Model 4). For eligibility requirements, various combinations were tested, and the count variable for status exclusions was more successful than the dichotomous variable. Outlier handling did not change the results. Because the m ix of categorical and continuous variables were settled upon, the twostep method without outlier handing was employed; the results for Model 3 are displayed in Table A 39. Two clusters emerged, and five cases were excluded. The number of violent felony ex clusions was the sole important variable for cluster determination in this variable group, according to the critical line tests. Cluster 1 contains all VTCs that exclude violent felonies (creamers), while Cluster 2 consists of the all purpose VTCs that do not exclude all violent felonies (Table A 39). Because of its importance, this violent felony exclusion variable was thus included in the full model (Model 4). The full model includes all variables deemed important by Models 1, 2, and 3: External funding One judge Maximum jurisdiction Management supervision means Treatment supervision means Therapeutic evaluations offered Management participation requirements Exclusion of all violent felonies Because these variables are both categorical and continuous, t he twostep method was employed, and four clusters emerged with five cases excluded. Outlier handling did not change the results. The results are depicted in Table A 40. Cluster 1 does not exclude violent felonies and offers many therapeutic evaluations. Cluster 2 also offers many therapeutic evaluations but, additionally, has

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131 structural variables contributing to its cluster (i.e., single presiding judge and city/municipal and state level jurisdiction). Both Cluster 1 and 2 have the most therapeutic evaluation areas, and the variable is important to each grouping. All four clusters include numerous therapeutic evaluations as a part of their missions and goals (all VTCs offer some type of treatment, which in turn, require evaluations); however, Cluster 1 is the only grouping that accepts participants regardless of charge status. It is because of both facts (highest mean for therapeutic evaluations and acceptance of violent felony charges) that I label this an allpurpose VTC cluster. Cluster 4 includes onl y VTCs that exclude violent felonies. Because of this exclusion, I label it a creaming court cluster. Additionally, VTCs in this cluster only have jurisdiction at the county level and have a single judge. This suggests that they are relatively small and target a specific type of veteran, those at a lower risk. Cluster 3 is only defined by the number of judges, specifically more than one judge, which is simply a structural variable. Funding sources, management supervision means, treatment supervision means, and management participation requirements, did not affect the creation of clusters. Little variability exists across management supervision means and managem ent participation requirements, indicating that all these courts are management courts. Although t hese courts are providing treatment, they also utilize management sup ervision means and requirements, indicating that management is so deeply engrained in these courts that it is a component of them all. This is an important finding because the literature (Chapter 2) has proposed a differentiation between therapeutic and management courts. Although preliminary, according to this null finding

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132 in these data, it appears that VTCs are management courts that also offer treatment services. There is no clear separ ation between these categories and management and therapy coexist within the VTC to certain extent. Because the jurisdiction level variable did not solely contribute to a cluster and the levels appeared to be dispersed randomly across the clusters, I ran an additional model excluding the jurisdiction level variable (Model 4b in Table A 41). Cluster 1 is still considered an allpurpose court cluster because is has the most therapeutic evaluation areas and is largely comprised of VTCs that accept violent f elony cases (69% ). Both of these variables contribute to its grouping. The creaming court cluster also still exists; it is Cluster 3 in this model. VTCs is Cluster 3 exclude all violent felony cases. The structurally defined cluster remains and is Cluster 2 in this model, which contains all of the VTCs with more than one judge. Funding source becomes an important variable to cluster creation. More of the creaming cluster (58% ) has more funding than the all purpose cluster (15% ), and the funding variable is important to both groupings. Typology Limitations and Conclusion Several limitations are associated with the statistical analysis. In cluster analysis, cases are dropped when variables have missing values, and dropping cases can affect the clustering. In this analysis, five cases (6 % ) were dropped from the eligibility clustering, which caused five cases (6% ) to drop from the full model. Cluster analysis did produce creaming and all purpose court clusters, which support one of the grouping assertions Howe ver, cluster analysis always result s in variable groupings and does not assess whether a variable is appropriate for inclusion. Thus, I plan to conduct future analyses using a variety of other variables (e.g., program size). Creating a typology of VTCs sho uld be pursued because, if VTC models were

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133 discovered and were categorized, researchers could compare and contrast specific elements or program efficacy with this knowledge in mind. Researchers may discover a particular model to be the most effective or sp ecify components of models that achieve their intended impact, make no impact, or are related to adverse outcomes These conclusions could lead to the creation of evidencebased VTC model s (Chapter 5)

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134 CHAPTER 4 CASE STUDY OF THE PALM BEACH COUNTY VETERANS TREATMENT COURT (PBCVTC) Case Study Overview This chapter presents t he indepth case study of a VTC After establishing an understanding of what is occurring nationally in Chapter 3, Chapter 4 describes in detail the operation, structure, and implementation of a single VTC To do so, I chose to employ the case study method. N umerous sources detail the purpose and methods of the case study approach (for example, Creswell, 2013; Creswell and Clark, 2011; McDavid e t al., 2013; Yin, 2011, 2012). Davey (1991:1) provides a concise yet comprehensive overview, which is quoted below. Case study methods involve an indepth, longitudinal examination of a single instance or event. It is a systematic way of looking at what is happening, collecting data, analyzing information, and reporting results. The product is a shar pened understanding of why the instance happened as it did, and what might be important to look at more extensively in future research. Thus, case studies are especially well suited toward generating, rather than testing, hypotheses. (Davey, 1991:1). In June of 2011, I contacted all operational VTCs in Florida, which were discovered through the process of creating the national compendium (Chapter 3). At that time, only three Florida VTCs were operational: Okaloosa County VTC Palm Beach County VTC (PBCVTC), and Miami Dade County VTC Of the three, I chose the PBCVTC because it had been in operation the longest (since November of 2010) and was a st andalone program (Miami Dade County VTC was connected to their drug court). I contacted several individuals from the PBCVTC to obtain permission for this study. The 15th Judicial District Court Administration and VAs VJO granted permission in July and August of 2011, respectively ( Table A 45, Figures D 3 and D 4).

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135 To understand the P BCVTCs operation, structure, and implementation issues two case studies were conducted: 1) exploratory case study 2) implementation case study. These case studies are explained and their results are presented and discussed in the f ollowing two sections of this chapter. Case Study One: Exploratory Because no research existed on VTCs at the time, the exploratory case study method is utilized. Exploratory case studies are used to obtain an understanding about various programs, policies, or other subjects of inquiry where there is uncertainty or no current knowledge (Datta, 1990; Davey, 1991). Research Design Here, the goal is to understand the PBCVTCs program operations, structure, and goals, as well as to develop measures for the im plementation case study Case Study Ones research questions are delineated below. 1. How was the PBCVTC established? 2. What are the PBCVTCs goals and mission statement? 3. Who is the PBCVTCs target population? 4. What is the PBCVTCs operational process? 5. How is t he PBCVTC funded? 6. What are the participation requirements? 7. What treatments and services are available? 8. What agencies work with the PBCVTC, what is their involvement, what roles are they prescribed? A single case embedded design (meaning one case with multi ple embedded units of analysis) was employed for the exploratory case study (Yin, 2012). The case is the PBCVTC, and the units of analysis are the VTC personnel and participants (Figure

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136 B 21). Informal direct observations of team meetings and court sessions were combined with my own informal interviews and conversations with the VTC team members as the means of gathering data on establishment, structure, and procedure. Once permission was granted by the VJO and Court Administration ( Table A 45, Figures D 3 and D 4), I began interviewing the VTC team members and sitting in on team meetings and open court sessions from September through December of 2011 (Table A 45). These data informed the construction of the observation and interview instruments (discussed i n the implementation case study section) and the items on the national survey instrument (Chapter 3). Exploratory Results Th e PBCVTC is a county level VTC located within the Fifteenth Judicial Circuit of Florida. In 2010, the Chief Judge of the Fifteenth Judicial Circuit reviewed a report by the Substance Abuse and Mental Health Services Administrations Center for Mental Health Services national GAINS Center and formed a task force consisting of representatives from the following agencies and institutions : Judiciary in the Fifteenth Judicial District State Attorneys Office Public Defenders Office Clerks Office Comptrollers Office Pride Probation Department of Corrections Probation Court Administration VA Stand Down House Vietnam Veterans of America Law Enforcement Administration This task force is known as the Veterans Committee and the results of the committee meetings comprise Administrative Order No. 4.90511/10 (Figure E 7) The Veterans

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137 Committee goal was defined as to improve public safety by providing meaningful treatment to address the needs of veterans while reducing recidivism (Figure E 7). To fulfill this goal, the Veterans Committee decided that: A veterans docket needed to be created for veterans with offenses ranging from municipal ordinance violations to felony crimes A fulltime caseworker needed to create individualized treatment plans for the offenders on the docket (funded by the VA) Services would be provided by the VA and community treatment providers Stand Down House and Vietnam Veterans of America would train mentors and run a mentor program The initial data (informal direct observations, interviews, and conversations described previously) made it clear that i ts causal hypothesis is that military experience results in speci fic problems for veterans, mainly mental health and substance use, and these problems, in turn, lead to contact with the criminal justice system. The PBCVTC believes that veterans who receive the appropriate treatment needed to improve their mental, behavi oral, and social issues will have a reduced likelihood of offending (in tervention hypothesis). The PBC VTCs mission is to improve veterans chances of avoiding future criminality and interaction with the criminal justice system by addressing the underlying health and psychosocial problems facing veterans through rehabilitation and treatment services. To achieve its mission, the 15th Judicial Circuit partners with various agencies. The agencies and their key players are listed below. 15th Judicial Circuit o f Florida o The Honorable Ted Booras (Judge) o MaryAnn Duggan (Assistant District Attorney) o Stephen Benedict (Public Defender) o Johanna Rivera (Public Defender, Focus on DMV) Department of Corrections Probation

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138 o Louis Kurtz (Probation Officer) Department of Vet erans Affairs o Carla Paula daSilva (Veteran Justice Outreach Specialist) o Frank Babich ( VA Treatment Provider Coordinator) Community Treatment Providers o Roy Foster ( Community Treatment Coordinator) Vietnam Veterans of America Florida State Council o Jerry Klei n (Mentor Coordinator) Employees of the 15th Judicial Circuit and DOC work within their respective budgets; no additional funding is provided to bring in additional court personnel or probation officers for the VTC project The VJOs salary is provided by a VA grant, and the VA Treatment Provider Coordinator is employed by the VA and exists within its already established budget and operation. The Community Treatment Coordinator and the Mentor Coordinator work for nonprofit organizations. An impact theory is comprised of assumptions about the change created by the program and what improvements are expected (Rossi et al., 2004). The program impact theory relates to the PBCVTCs mission, which holds that addressing the underlying causes of criminal behavior w ill improve the veteran in various ways. Again, various treatment providers partner with the court to provide services aimed at address ing these issues. Treatment providers within and outside the VA include mental and behavioral health (including substance abuse), medicine and surgery, primary care, spinal cord, reproductive care, specialty care, oncology, physical rehabilitation, prosthetics, and dentistry services, as well as vocational training. Figure B 22 is a results based logic m odel (McDavid et al., 2013) for the PBCVTC based on the programs theory of change. The logic model identifies and displays the programs inputs and process (grey), components and activities (red for treatments and services), direct outcomes (yellow), indirect outcomes (orange), and final outcomes (green), as well as the linkages

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139 between these elements. For example, when looking at mental health and/or substance abuse treatment, one can follow the chart and see that, through the VTC mandates (grey), participants received mental health and/or substance abuse counseling (red). These treatments (red) teach participants coping mechanisms (yellow) and the underlying reasons for these issues (yellow), as well as provide reintegration and adjustment aid (yellow) and increase responsibi lity and support (yellow). All of these learned mechanisms, understandings, and training (yellow) are meant to reduce substance abuse/relapse and/or mental health issues1 (orange). The reintegration and adjustment, responsibility increase, and feelings of support (yellow) goal is to reduce isolation and feelings of loneliness (orange), which, in turn, may contribute to the reduction of substance abuse/relapse (orange). The reduction of substance abuse and/or mental health issues (orange) may lead to a reduc tion in violent behavior (orange) and homelessness (orange). The development of coping mechanisms (yellow) may also directly reduce violent behavior (orange). These improvements should lead to positive outcomes. Continuing with this example, reductions in substance abuse, mental health issues, homelessness, and violent behavior (orange) are expected to result in the reduction/elimination of criminal charges in VTC (green) and the absence of contact with the criminal justice system in the future (green). These two outcomes can also facilitate the process of becoming a productive member of society (green), which can, in turn, reduce isolation and feelings of loneliness (orange). 1 The relationship between these reduction in substance abuse and mental health issues is also reciprocal.

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140 The target population for the PBCVTC is very inclusive The program accepts both VA eligible and ineligible veterans and current active duty personnel2 who have committed a crime (infractions, misdemeanors, and felonies, including violent felonies) excluding murder (homicide category) or rape in Palm Beach County. The Service Utilization Plan (Figure B 23) shows how the target population is reached and the sequence of services provided (Rossi et al., 2004). The initial identification potentially eligible veterans happen at three points: pretrial, arraignment, or somewhere through the tr aditional adjudication process. A potentially eligible veteran charged with a misdemeanor or felony ( other than rape or homicide) is asked by the identifying judge or lawyer if they are willing to participate in the VTC in lieu of the traditional court process. If the veteran chooses not to participate (initial opt out) he or she will continue on with the traditional adjudication process. If the veteran initially chooses to participate, he/she is put on the VTC docket and put in contact with the Veterans J ustice Outreach Specialist (VJO) to determine military status The veteran must both appear before the VTC and meet with the VJO; these stages occur in no particular order (Figure B 23) T he VJO verifies the veterans military status, i.e. veteran active duty, or civilian by the presence of their discharge papers (DD 214) or enlistment status (Figure B 23) If a defendant is determined to be a civilian, they are not eligible for the VTC and are processed through traditional court. Once a defendant is ver ified to be a veteran, the VJO then determines his or her VA eligibility3. Both VA eligible and ineligible veterans are able to participate in VTC. The type of VA eligibility establishes whether services, 2 For the rest of this chapter, the use of the term veteran applies to both veterans and active duty personnel because active duty personnel comprise les s than 5% of the PBCVTC participant sample (see Case Study Two: Implementation), as well as for the sake of convenience. 3 For VA eligibility requirement s, see Figure E 1.

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141 such as mental health and substance abuse treatment will be provided by the VA or through an outside treatment provider. The VJO also conducts an entry evaluation to obtain demographics and determine what services the veteran needs4. The veteran also signs a medical release for the VA for treatment providers to share information with each other and the VTC5. Using the results from the evaluations, the VJO links the VA eligible veterans to the appropriate services within the VA through the treatment coordinator, and the community treatment coordinator links VA ineligible veterans to the appropriate services provided by outside agencies. The VTC team meets on Wednesday at 11:00 a.m. to review the veterans on the docket for Thursdays court session. The VTC team consists of the judge, public defender, assista nt district attorney, VJO, probation officer, community treatment coordinator, and DOC and PRIDE probation officer s, as well as private counsel if it has retained by a veteran. The VJO reports whether the veteran has met with her The VTC members discuss t he following elements of a new defendants case: Evaluation results Needs A ssigned treatment (e.g., housing placement, substance abuse, anger management) W hether probation is required and what probation terms are require d W hether other legal obligations will be mandated (e.g., restitution, DUI school, community service) Whether, and if so which, mentor is to be assign ed What to do with the current criminal charges 4 For VJO Contact, VJO Entry, and Homelessness Assessment evaluations, see Figures E 3, E 4, and E 5, respectively 5 See Figure E 6

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142 If the veteran has not met with the VJO, the VJO assures the team that she will set up an appointment with the veteran at the veterans appearance in court the next day. For participating defendants, the VTC team discusses the following elements: Treatment compliance, problems, progress, achievements, and any other updates Court mandate compliance, problems, progress, achievements, and any other updates Update on needs Updates from mentors Social support updates Financial, employment, and school updates New legal infractions Treatment providers provide the VJO and community treatment provider coordinator with information regarding compliance, participation, progress, and appointment s kept, rescheduled missed, or not rescheduled. The VJO and community treatment provider relay this information to the VTC team The mentor coordinator informs team m embers of problems and progress which were provided by the assigned mentors. The probation officer, public defender, and ADA attest to violations and compliance. The VTC team then uses all the information provided to determine the veterans status, which results in a scheduled status check and meting out a sanction or a reward. For status checks (appearances for participating veterans), the VTC informs the veteran participant of the VTC teams decisions made in the team meeting. For first appearances (vet erans just entering the VTC) the results of the VTC team meeting are relayed to the veteran. The public defender informs the veteran whether the charges will be downgraded, remain pending until completion, or dropped upon completion. The

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143 ADA and judge exp lain to the veteran what requirements the VTC is mandating (participation requirements) e.g. completing probation, attending DUI school, restitution, or obtaining a valid drivers license. If probation is required, the probation officer informs the veteran of the terms of his/her probation. If the veteran has already met and been evaluated by the VJO the VJO re informs the veteran of the treatment services in which he or she is required to participate. If the veteran has not met with the VJO to date, the v eteran and the VJO set an appointment for the evaluation. The veteran then decides based on the information provided, whether he or she want s to participate in the VTC If the veteran wants time to think about the opportunity, the veteran is placed on the docket for the next VTC session where he or she will report his or her participation decision ( plea conference) If the veteran declines, the case is transferred back to traditional court. If the veteran accepts, the veteran plea d s to the charges, accepts the requirements, and is assigned a mentor (in some cases) That case is then placed on the calendar for the next appearance date (status check) T he PBCVTC is designed to have veteran participate in the mandated treatment and meet with the assigned vet eran mentor (if assigned) with in the time period before the next VTC appearance (status check). T he day before the VTC session, the VTC team meets and reviews each defendant on t he docket There is no set path through the program as a whole through specifi c phases or through a reward and sanction ladder. Figure B 23 illustrates this process; this figure also lists some of the rewards and sanctions that may be applied Graduation from the pr ogram is entirely dependent upon the judge and district attorneys d efinition of success. Definitions of success vary among the VTC team members and are listed in Table A 46 Progress in relation to eachs

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144 definition is reported by the respective team members is discussed at all VTC team meetings and updates and elaborati ons that have occurred in the last 24 hours can be brought up by team members at the VTC session. The creation of a logic model is important to the development of performance measures (McDavid et al., 2013). Based on Figure B 22, I was able to list process and impact goals (Rossi et al., 2004) as well as the corresponding process and outcomecentered performance indicators (Rossi et al., 2004), or measures (McDavid et al., 2013) in Table A 47 Process goals reflect the manner in which creators or administr ators want their program to operate and obtain its target population, while impact goals define the changes the program wants to produce in their participants, community, etc. (Rossi et al., 2004). Table A 47 lists the PBCVTCs various process and impact g oals and the corresponding process and outcome centered performance indicators. Conclusion Through informal direct observations, interviews, and conversations, the exploratory case study has provided a detailed picture of the PBCVTCs structure, operation, goals, and target population, culminating in a results based logic model (Figure B 22), service utilization plan (Figure B 23), and process/impact goal and measurement table (Table A 47). Case study one has laid the groundwork for the implementation case study The process/impact goal and measurement table becomes an important tool in the operationalization of process measures for the implementation study (case study two) and the operationalization of impact measures for future studies ( Chapter 5). Additi onally, t his exploratory study allows us to see where it falls in regard

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145 to structure, operation, mission, and target population with in the national landscape (Chapter 5) Case Study Two: Implementation To understand whether implementation issues exist wi thin the PBCVTC, I conducted an implementation case study (or pro gram implementation case study). This type of case study s purpose is to determine whether a program is being run as it was intended to operate ( i.e., whether the program in action is functioning as planned) (Datta, 1990; Davey, 1991) Longitudinal data collection and a wide array of information collected are necessary to produce a good implementation case study (Datta, 1990; Davey, 1991). Often, these implementation case studies are conducted across sites. Research Design and Data Collection For case study two, the general goal was to understand whether the PBCVTC was being implemented as planned. T he PBCVTC operates independent of other VTCs because a single model (or series of models) of VT Cs with multiple courts operating under set guidelines does not exist Thus, this implementation case study is a single site study, requiring a singlecase embedded design (Figure B 22). The following research questions were created in an effort to obtain a wide breadth of information to achieve this understanding. 1. Is the PBCVTC reaching its target population? ( Who are these veteran participants: demographics, military history, offenses, issues they face) 2. Is there discrepancy between eligibility, screening, and admittance? 3. Is there deviation from other policy and planned procedure? To gather the requisite information, longitudinal data were collected through direct observations and inperson interviews. The instruments described in the following

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146 subsections were based upon the data compiled in case study one, specifically my informal direct observations of team meetings and court sessions, interviews with personnel, and conversations with personnel as well as from case study ones results (logic model, ser vice utilization plan, and goal and performance indicator table) During the fall of 2011 and spring of 2012 (Table A 45), I created four str uctured observation instruments (Table A 48) six base participant interview instruments with three to six subsecti ons depending upon the base (Table A 49) and one mentor interview instrument with three subsections IRB granted approval for the initial interviews on June 25, 2012 (#2012U 059)6. These instruments are explained in the following subsections7. Team meeti ng structured observations I created t wo structured observation instruments for the team meetings: one for the team meeting itself (instrument 1) and for each veteran discussed during the meeting (instrument 2). As noted in Table A 45 the team meeting obs ervation instruments were finalized in the spring of 2012 and exempted by I RB in April of 2012 (#2012U 0487)8. Both instruments consisted of closed, hybrid, and openended items. The instrument for the team meeting itself (1) was comprised of items addres sing the following: Meeting length 6 See Figure D 10 for approval documents. 7 The data collected from these instruments was used for both case study two and three, so some of the information listed in the following sections may now specific ally be employed in case study two. However, all information collected is laid out in the following subsections to provide a scope and depth of the study, as well as for purposes of presentation structure (i.e., these instruments will not be explained in detail in case study three because additional instruments need to be detailed in that design section). 8 See Figure D 6 for the IRB exemption letter for observation of team meetings.

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147 Numbers of participants on docket and discussed Attendees Team member interactions, involvement, knowledge, and agreement Meeting structure Fair outcomes Time management Distractions Totals for offense types, gender, and deemed compliant and noncompliant Totals for arraignments, plea conferences, and status checks scheduled Any additional notes and narrative comments The instrument for each veteran discussed in the team meeting (2) had items addressing the following areas : Reason on docket Counsel VA eligibility Charges Participation eligibility Participation requirements Requirements, successes, failures, and problems discussed Determination of compliance VTC team decision Agreement of VTC team Any additional comments Fr om May through August of 2012, I observed the VTC team meetings and collected data using these two structured observation instruments (Table A 45). Prior to the meetings start (Wednesday, 11:00 a.m.), I would assign a code number for the team meeting and fill in the code number in the appropriate area on the team meeting instrument (1). Additionally, I received the docket up for discussion at the meeting either the evening before or the morning of the meeting. Once I received the docket, I assigned a code number to each veteran and kept this information in a master list (discussed in detail later) The cover page for the veteran team meeting instruments (2) is a tear off sheet where I wrote the veteran names The data collection items began on

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148 the second page, and I wrote both the veterans assigned code number and the team meeting code number in the specified spaces. During the meetings, I sat away from the table near the corner, so VTC team members could not see any of the code numbers and I would not dis turb their proceedings. Once a veterans name was called, I would pull the corresponding instrument (2), tear off the top cover sheet containing the veterans name, place sheet in a folder, and fill out the instrument. The cover sheets in this folder were shredded off site after each team meeting.9 Op en court structured observations I created t wo structured observation instruments for the court sessions: one for the VTC session itself (instrument 1) and one for the veterans called before the court (instrum ent 2). As noted in Table A 45, the open court observation instruments were finalized in the spring of 2012 and exempt ed by IRB in April of 2012 (#2012U 0489)10. Both instruments consisted of closed, hybrid, and openended items. The VTC session instrument (1) had items addressing the following areas: Meeting length Numbers of participants on docket and discussed Attendees Team member interactions, involvement, knowledge, and agreement Meeting structure Fair outcomes The VTC teams interaction with, treatment of, and relationship with the veteran Family testimony Time management Distractions 9 Please see Figure D 5 for further detail of the security protocol and d ata collection procedure during team meetings. 10 See Figure D 8 for the IRB exemption letter for open court observations.

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149 Any additional notes and narrative comments The instrument for each v eteran appearing in the session (2) gathered information on the following elements : Presence If ab sent, reasons, sanctions, and decisions related to absence Appearance type Explanation of process Participation eligibility Agreement to participate Veteran progress, improvement, problems, failures, challenges, accomplishments Encouragement, recommendatio ns, and understanding from judge Requirements, successes, failures, and problems discussed Updates Family or mentor testimony Rewards Sanctions Agreement of VTC team Next appearance Any additional comments From May through August of 2012, I observed the court sessions and collected data using these two structured observation instruments (Table A 45). For data collection in open court, I followed the same security protocol as the team meeting. The court instrument for the veterans (2) contained a tear off cover sheet. Prior to court, I would assign and write the court session number on the session instrument (1) and the second page of the veteran instrument (2). I would then check the docket and my master list (discussed in detail later) and write the veterans names on the tear off cover sheets and their assigned code numbers on the second sheet where the items began. During the VTC session, I pulled the corresponding instrument (2) each time a veteran was called before the court, remove the cover page wit h the veterans name, place it in a folder, and fill out the instrument. After the court session concluded, I shredded the

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150 cover sheets located in the folder off site.11 Additionally, I sat either at the back of the courtroom or to the right of the public seating in the courtroom to assure that no other individuals could read the code numbers. Initial interviews I created six base initial interview instruments, one for each type of veteran in contact with the PBCVTC. The six groups of veterans are defined b y their status during Wave I of data collection: Veterans starting veteran court ( Group 1) Veterans already participating (Group 2) Veterans who chose not to participate in VTC (opt out) Veterans already participating who dropped out of VTC (drop out) Vet erans already participating who were terminated by the VTC (terminated) Veterans already participating who graduated from VTC (graduated) All i nitial interview base instruments were comprised of closed, hybrid, and openended items for veterans addressing the following areas: Demographics Military experience and status Current legal charges Previous legal charges and criminal history VTC process and agents Mentoring Other services and court requirements Additionally, items measuring change in these areas were included in the instruments for the veterans who were already participating when wave 1 of data collection began (i.e., II, drop out, terminated, and graduate groups). Finally, specific items related to currently participating, opting out, dropping ou t, being terminated, or graduating were included in the respective instruments. 11 Please see Figure D 7 for further detail of the security protocol and data collection procedure for open court sessions.

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151 I created subsections for housing, substance abuse, and mental health to be used for veterans identified with these issues. I identified veterans with these issues through the VJOs recommendations of services and by the legal charges. For example, if veteran was in the VTC because of a DUI charge, I administered the appropriate base instrument and the substance abuse subsection. If a veteran was mandated to participate in subst ance abuse and mental health treatment, I administered the appropriate base instrument and both the substance abuse and mental health subsections. All subsection instruments contained closed, hybrid, and openended items. As seen in Table A 49, different h ousing subsections exist to correspond with the six groups of veterans. Housing subsection (B) contains items on previous par ticipation in housing programs ( whether how many, and why they switched programs if applicable) and housing status and change over the last 3 months and why. Housing subsection (IIB) contains the same items as (B) but also asks how many housing programs the veteran has been referred to by the PBCVTC. Instrument (IIB2) is filled out for each of the programs the veteran has been referr ed to by the PBCVTC. Instrument (IIB2) gathers information on the program, specifically, length of stay, which agent specifically referred the respondent, who pays for the service, what the requirements of the program are, their level of comfort (and why he/she feels this way), whether he/she currently lives there (if so, what are the future plans), whether the facility has helped (and why), services offered and participated in, and changes he/she would make.

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152 Several substance abuse subsections were create d to correspond with the different groups of veterans (Table A 49). Both subsections (C) and (IIC) begin with the 29item TCU Treatment Motivation Scale focused on substance use, which capture three stages of treatment readiness: 1) recognition of the problem 2) desire for help 3) readiness for treatment. Both (C) and (IIC) then have several items about the use of stimulants, marijuana, alcohol, depressants, and hallucinogens/psychedelics, which address : frequen cy of use of the last 3 months if the subst anc e can be legally prescribed whether there was a legal prescription if it was us ed as prescribed (if not, how) why the respondents uses the substance whether it is used in combination with other substances (if so, which) changes in use over the last 6 mont hs Both instruments ask whether the respondent has ever thought he or she has had a drug or alcohol problem (if so, when) and whether he/she has every been told that he or she does (if so, when and by whom). They record information on whether the veteran has participated in treatment before the VTC (if so, what types and whether it was voluntary). Information on the temporal ordering of military service and substance use and of military and alcohol consumption is collected as well as changes, timing of ch ange, and believed causes of change or maintenance. The instruments obtain information on whether the PBCVTC referred him/her to treatment programs within the VA, outside the VA, or both, as well as whether he/she believes he/she needs treatment. Instrumen t (IIC) also asks how many substance abuse programs they have participated in while in the PBCVTC. The amount of ( IIC2 ) instruments used depends

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153 upon this answer because this instrument gathered data on the substance abuse programs the veteran participates in while in PBCVTC, specifically: length of time in treatment who referred length of time from referral to start treatment modalities and frequency who pays for treatment assessment and evaluation process program requirements techniques learned (and whether used, whether helpful, and why) medication prescribed (and whether used, whether helpful, and why) responsiveness of providers to questions and treatment needs attendance (and why) legitimacy compliance (deemed by program and self report) rewards and s anctions supervision means and frequency level of comfort and why whether needs were met and why program satisfaction and why overall efficacy and why likes/strengths and dislikes/weaknesses improvements and changes overall level of satisfaction level of growth, change, and recovery (and why) Several mental health subsections were created to correspond with the different groups of veterans (Table A 49). Both subsections (D) and (IID) begin with the 29item TCU Treatment Motivation Scale, which was adapted for mental health, and continue on to discern whether the individual experienced a mental health issue at some point in the life course, and if he/she had, what the specific issues were and w hen they experienced them (i.e., before, during, or after military service not mutually exclusive). Both instruments then ask whether they have seen a physician or counselor for or been formally diagnosed with a mental health issue. If they have, items then gather information on the specific diagnoses and/or the issu es that brought him/her to the

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154 mental health professional, as well as when this attention occurred (i.e., before, during, or after military service and before entry into VTC, at the VJO evaluation, or after VJO evaluation not mutually exclusive). Information is gathered on whether the respondent participated in mental health treatment prior to entering the VTC, and if so, what the treatment modalities were and whether treatment was voluntary. Both instrument ask whether the PBCVTC referred the respondent to mental health treatment(s) within the VA, outside the VA, or both. For veterans who were already participating in the VTC at Wave I data collection, instrument (IIC2) was administered for each mental health p rogram required by the PBCVTC, which gathered program information on: length of time in this treatment current participation status who referred length of time from referral to start who pays for treatment assessment and evaluation process program requirements treatment modalities and frequency techniques learned (and whether used, whether helpful, and why) medication prescribed (and whether used as directed, helpful, and why) responsiveness of providers to questions and treatment needs attendance (and why) legitimacy compliance (deemed by program and self report) rewards and sanctions supervision means and frequency level of comfort and why whether needs were met and why program satisfaction and why treatment quality overall efficacy and why likes/strengths and dislikes/weaknesses improvements and changes overall level of satisfaction level of growth, change, and recovery (and why)

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155 F rom June through September of 2012, I made contact with and conducted interviews with the veterans appearing in the PBCVTC (Table A 45). At the weekly VTC sessions, I ap proached the veterans appearing before the court and provided them with recruitment letter (Figure D 9). Upon review of the letter, I either set up an interview appointment with them or they later contacted me to schedule a time. If they missed their appoi ntment, I did not contact them more than three times to reschedule. At the appointment, I provided them with and read through the letter of consent with them; they then signed one for me and kept the second for themselves. I then asked respondents if they would consent to have their interview audio recorded. I used the veteran code numbers from the master list as the identifiers on the instruments. No names were included anywhere on these instruments and were, if vocalized in the interview, removed from all transcriptions12. I interviewed 50 veterans, and two trained research assistants interviewed an additional nine veterans, resulting in a total of 59 interviews. Interview lengths ranged from 45 minutes to 2 hours and 14 minutes averaging around 1.5 hours Data Management Audio file names were titled as the corr esponding veteran code numbers and were transcribed by a team of research assistants. Names or nicknames of the veterans, if contained within the audio files, were not transcribed. The transcription files were independently triplechecked by a team of research assistants; the research assistants were not assigned to check files they had transcribed themselves and were not assigned a file more than once to check. I conducted a final fourth check of eac h 12 For a det ailed description of the data collection and security protocol, see Figures D 9 and D 10.

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156 transcription file. Once all transcriptions were complete and deemed accurate, I then destroyed the audio files per IRB protocol. Using the veteran code numbers as case identifiers and team/session code numbers as team/session identifiers, I created seve ral data sets. I made individual data sets for the initial interview and subsections using the case identifiers for the 59 participants (each case included a variable for group membership, as well). I also created a data set for the court sessions and a da ta set for the team meetings using assigned team/session identifiers. Data from the structured observation instruments for all eight court sessions and seven team meetings that occurred during Wave I were input into these data sets. For the seven team meet ings and eight court sessions, data were also collected on each veteran in the team meeting and court session structured observations for the veteran. For these data, I created data sets for each team meeting and session using the case identifiers to disti nguish cases. These data are longitudinal for the veterans who appeared on the docket several times over those eight sessions/meetings. The quantitative data and qualitative data underwent several steps to ensure accuracy in coding and entry. S everal research assistants and myself entered the quantitative data from all of the instruments (Tables A 48 and A 49) The quantitative data sets were triplechecked for accuracy, and I conducted a fourth and final check of all data entered. For the qualitative data contained in all of the instruments and corresponding audio files (Tables A 48 and A 49) the research assistants and myself thematically coded the data over several meetings. Focusing on the qualitative responses, I assigned each research assistant and m yself a group of transcription files

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157 (Table A 49) and instruments containing qualitative data (Tables A 48 and A 49) and we independently created themes for responses of the qualitative items. Once we thematically coded our first group of transcription fi les, we switched groups and repeated the process. The groups of transcription files underwent this process by each member of the team and myself. Once the groups of files made it through each team member and myself, we combined themes where necessary, and I assigned a code number to each theme. The transcription qualitative items were then coded according to this list. To assure accurate coding, the coding assigned to each qualitative item in each transcription file was independently triple checked, and I c onducted a final fourth check to assure accurate coding was achieved. I maintain a digital master list of the names and cor responding veteran codes (case identifiers) This list and the data files are kept on a partitioned section of my laptops hard dri ve, which has been both encrypted and password protected. This laptop is not shared. Only I have the password for the laptop as well as for the hard drive and files on the encrypted and passwordprotected partitioned section of the computer. Additionally, before accessing the partitioned (encrypted and password protected) section of the hard drive, the Internet connection is disabled The list and data files are backed up on one encrypted and passwordprotected flashdrive and one encrypted and passwordpro tected external hard drive. These external drives are stored in a locked filing cabinet at my home office, and only I have a key to the filing cabinet Only the laptop was taken on data collection trips13. 13 For more detail on data security and collection, please Figures D 9 and D 11.

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158 The Samples Depending upon the process goal examined, various samples are utilized in this case study in an effort to form a complete study of implementation. Two samples of veterans were used: the structured observation sample (n=129) and the interview sample (n=59). Additionally, a sample of court sessions (n=8) and a sample of team meetings (n=7) were also utilized. The i nterview s ample During May through August of 2012, 129 veterans from five groups (i.e., participating prior to Wave I beginning participation in Wave I opt out, terminated, and graduated) were on the docket in the PBCVTC and were thus discussed in the team meetings and called in court sessions Of these 129 veterans, six were deemed ineligible for PBCVTC participation (Table A 52) during the team meetings Reasons for ineligibility inc luded a one conflict of interest for the public defender (specifically, the public defender was representing the codefendant in the downtown court), one fugitive felon, one did not have enough time in service, two were not U.S. veterans (i.e., one was a f oreign veteran and one was a civilian), and one case was dismissed and sent to residential treatment facility (Table A 52). Of th e 123 eligible veterans left, 22 were unable to be recruited for an interview (Table A 53) for the following reasons: eight wer e incarcerated, six were in reside ntial treatment three died, three resided outside of the jurisdiction (i.e., Tampa, New Jersey, and Virginia), and two were deployed for the duration of Wave I (Table A 54). This resulted in 101 eligible veterans able to be recruited for an interviewed. Additionally I chose not to interview one of these veterans because he records both audio and video at all times using a camera in his glasses (Tables A 53 and A 54) He had a federal case pending regarding this recording on the

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159 premises of the VA Medical Center; it is a federal crime to record without authorization in federal buildings. These eliminations produced a sampling frame of 100 veterans. When initially recruited at court, f ive veterans refused to participate (Table A 53) because they were either very busy (three veterans) or were fed up or mad at the PBCVTC (two veterans ). Ninety five ve terans agreed to be interviewed, and I provided these veterans with the recruitment letter and my contact information. T hey either scheduled an appointment or provided me with their contact information at that time. Twelve veterans set up interviews but did not show up and did not return my three subsequent contact attempts. Twenty four veterans were unreac hable to schedule an interview they did not return any of my three contact attempts (16 veterans) or their contact information was no longer in service at the time of attempt (eight veterans) A total o f 59 veterans were interviewed. I interviewed 50 veterans and two trained r esearch assis tants interviewed nine veterans The general response rate for the initial interviews was 48% (59 veterans out of 123 eligible veterans on the docket ). T o achieve a more accurate picture of the response rate and to calculate the cooperation, refusal, and contact rates, I utilized the AAPOR Respon se Rate Calculator (Chapter 3) for the 129 veterans (appeared on the docket during Wave I ) U sing the information on eligibility, participation, refusal type, and other exclusions in Tables A 52, A 53, and A 54, I created outcome rate categories in Table A 55 to compute the AAPOR rates. The AAPOR rate estimates are listed in Table A 56. The A APOR minimum response rate is 48%, which is the same as the general response rate initially computed. COOP1 and C OOP3 rates varied greatly at

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160 60% and 92%, respectively. The COOP3 rate is higher because it defines those who are unable to be interviewed as incapable of cooperating (Chapter 3). The refusal rate is low at 4%, and the contact rate is 81%. This group of individuals was difficult to contact with 24 being unreachable after agreeing to participate ( 16 did not return voicemails, 8 either had full voicemail boxes or no voicemail set up so message could be left ) and 12 missing scheduled interviews (then not retur ning messages). The final sample (n=59) contained veterans from five groups (Table A 53) Group 1 (i.e., those beginning VTC participation during Wave I ) contained 20 veterans, and Group 2 (i.e., those veterans who had begun participation before Wave I ) wa s comprised of 26 veterans. There were seven veterans interviewed that opted out when offered the opportunity to participate (opt out), five veterans who graduated, and one veteran that was terminated by the PBCVTC. No veterans who appeared during Wave I d ropped out of the PBCVTC. T he samples demographics and military characteristics are displayed in Tables A 57 and A 58, respectively The majority of the sample is male (95%), white (56%), over 50 years of age (31% between 51 and 60, 20% 61 or older), not legally employed (80%) or enrolled in school (90%), and living in a residence they rent or own (58%). The sample majority also has a high school diploma as highest education level (49%) and no children (36%) and is single (34%) or divorced (27%). The majority of veterans have been honorably discharged (93%), enlisted at young ages (31% at 18 years of age, 22% younger than 18), served in the Army (37%) and in the Vietnam (37%) and post Vietnam (32%) eras, did not serve in a legally classified combat zone (61%), were deployed (54%), and suffered some type of mental or physical injury in service (75%)

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161 but were not discharged due to these injuries (only 25% of those with injuries were discharged due to those injuries). The structured observation sample (sampli ng f rame) Information was gathered on the full sampling frame (n=129) during the structured observations. However, the only instruments used to gather information on those that did not participate in the interview were the team meeting and court session st ructured observation instruments. From these instruments, I am able to ascertain the types of offenses that brought these veterans to the PBCVTC as well as their VA eligibility status and reasons for ineligibility Offenses were categorized into five types: traffic, drug, violent, property, weapons, and miscellaneous. The majority of the charges were traffic offenses at 137 charges (Table A 63). Drug charges were the second most prevalent with 59 charges (Table A 59). Violent offenses were the third most represented type of offense with 32 (Table A 60) and property crimes were the fourth with 29 (Table A 62). Eight weapons charges (Table A 61) and 22 miscellaneous charges (Table A 64) were on the dockets of the 129 veterans. The majority of veterans (87% ) were VA eligible (Table A 65) meaning they had an honorable discharge status and were not currently incarcerated ( Figure E 1). VA eligibility was unknown for three percent of the 129 veterans and was still being determined during Wave I The 10% that were VA ineligible were ineligible mainly due to currently being incarcerated. The team meeting and court session samples In addition to collecting data on the participants, I collected data on both the team meetings and the court sessions. Fourteen weeks w ere included in the structured

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162 observation period from the week of May 14th through the week of August 13th of 2012. However, only seven team meetings and eight court sessions occurred during this timeframe due to one week long training session and several vacation weeks during these summer months. Specifically, court sessions were cancelled during the weeks of June 18th and 25th, July 16th and 23rd, and August 6th and 13th. Results and Discussion Focusing on the four research questions for case study two and using the goals and indicators determined in case study one (Table A 47), this case study examines the following eight process goals to explore implementation. 1. Reach the target population 2. Early identification of veterans in criminal justice system and placement in VTC 3. Early evaluation of veterans in VTC by the VJO 4. Quickly link veterans to services based upon the VJO evaluation 5. Ongoing interaction between VTC judge and the veterans 6. Ongoing interaction between veterans and mentors 7. Partnerships between the court, DOC, nonprofit organizations, and VA and community treatment providers 8. VTC team working together in a nonadversarial manner These goals and their respective performance measures, as well as the location of the corresponding data, are listed in Table A 75. The following eight subsections determine whether the process goal s were achieved by explaining the data utilized and discussing the results and limitations as well as possible mechanisms for achievement and/or failure where possible. Screening process and r eaching the target population This subsection addresses process goal one, whether the PBCV TC has been reaching i ts target population : veterans (no discharge status exclusions) with underlying health and psychosocial problems who have committed a crime or infraction in Palm Beach County, excluding charges of homicide and rape. To do so, I utilized military

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163 status and personal issue from both samples to achieve a greater understanding of who the participants were Additionally, I examined both the official reasons provided by the team in court (court structured observations) and discussions from the team meetings ( team meeting structured observations) to evaluate the screening process Upon examination of the interview sample (Table A 58, n=59) a nd sampling frames (Table A 65, n=129) VA eligibility information participants mainly have honorable discharge status (93% for interview sample, 87% for sampling frame) Dishonorable discharge status is not represented in the sample or the sampling frame but general discharge types and less than honorable discharge statuses are present. Additionally a currently enlisted serviceman (not yet a veteran) was participating. Upon review of the reasons for ineligibility given to the veteran and audience in court (Table A 52) and review of the eligibility discussion notes in the team meeting observations, no veteran was excluded because of any type of discharge status A wide variety of offenses were also allowed into the PBCVTC, ranging from traffic violations to violent offenses. Based on the court data, t he VTC team did not exclude veterans based on offenses Further, upon review of the team observation data, no exclusions were made based upon offense type. However, although not contained in the mission statement or discussion of the target population, the victims of violent crimes had to consent to the veteran offenders participation. Without their consent, the veteran would not be eligible for the PBCVTC. During Wave I all veterans charged with violent cri mes were permitted to participate because all victims consented to their participation.

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1 64 When reviewing the team provided reasons for deeming veterans ineligible (Table A 52), the reasoning in all but two cases app ear to coincide with the mission and eligibility policy The two exceptions were not enough time in service and case dismissed and put in residential treatment. Time in service is not an eligibility requirement for the PBCVTC. The qualitative data from the team meeting reveals that not enough time in service was an explanation of ineligibility created by the team to provide the veteran in court, but t his veteran w as actually excluded because the team felt he would not r eform and was too much trouble. This was the only instance where the tea m provided reason (court observation) did not match the reasoning behind the decision in the team meeting (team meeting observation) Additionally, other veterans were participating in the PBCVTC during Wave I although they did not have enough time in serv ice for VA eligibility. For case dismissed and put in residential treatment a ccording to the team meeting discussion data, the team felt the veterans mental issues were severe and that it would be best to dismiss his case ( an open container violation) if he agreed to immediately enter inpatient treatment. Although he was excluded from PBCVTC participation by having his case dismissed, he was diverted to treatment, which is consistent with the courts mission. The other reasons for ineligibility coincided with the PBCVTCs policy or overriding court protocol : conflict of interest, fugitive felon, and civilian defendants. Whether the PBCVTC is reaching veteran offenders with health and psychosocial problems was determined. However, t he term psychosocial is very broad, meaning to involve both psychological and social aspects (Merriam Webster, 2013). The veterans all committed some type of offense (e.g., crime or minor infraction) that brought them to

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165 the PBCVTC. The fact that they have all committed a c rime or infraction against society means they all have a social (legal) issue. The PBCVTC does not contain any veterans without at least one social (legal) issue, so it is achieving its target population in the broadest sense and not overreaching its targe t population. To understand the issues confronting the participants, Table A 57 displays the issues faced by the interview sample, based upon the VJOs evaluation. Nearly half of the veterans evaluated by the VJO that were interviewed were diagnosed with substance abuse issues (46%), and 44% were diagnosed with mental health issues. Homelessness was the third most commonly reported issue faced by the sample with 12%. When looking at the individual cases, only 12% of the cases in the interview sample were not diagnosed with issues the VJO evaluates (i.e., physical health, mental health, substance abuse, transportation, homelessness, or lack of benefits where due). Nearly one third (32%) were diagnosed with two issues, and more than one quarter (29%) were diagnosed with only one issue. Additionally these veterans do have legal issues as previously discussed. Overall, the PBCVTC appears to be obtaining its target population and following its policies of screening and admittance. Of the 129 veterans that appear ed, only six were deemed ineligible, and of those six, only two exclusions were called into question. One exclusion (not enough time in service) clearly deviated from both the mission and policy. The second exclusion questioned (case dismissed and put i n residential treatment) appears to deviate from policy with the case dismissal but follows the mission by applying treatment to the psychosocial problem.

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166 Unfortunately, it is impossible at this juncture, to see the amount of veterans in the criminal justice system not appearing before the PBCVTC. It is possible that veterans may be refusing to even appear in the PBCVTC when asked by agency or institutional personnel. To understand this number, all personnel with agencies and institutions in contact with offenders (e.g., law enforcement, corrections, all courts within the jurisdiction) would have to report whether a veteran offender refused to appear in PBCVTC. However, I believe this number is relatively low and offenders would rather appear in PBCVTC fi rst and then opt out for several reasons. First, appearing in the PBCVTC does not equate to participation. Second, transferring a case to PBCVTC for appearance delays adjudication. Additionally, it is evident that some offenders do appear in PBCVTC but the n decline to participate. During Wave I 15 offenders (12% of the sampling frame) appeared in the PBCVTC and decided not to participate (opt outs in Table A 53). Finally, many veterans have had their cases automatically transferred to the PBCVTC without their consent (discussed in the next subsection). Early identification and case transfer For the second process goal, early identification and placement into the PBCVTC is vague because early is not clearly defined. Early is defined by the PBCVTC team mem bers as close to the date of entry into the criminal justice system, which I interpret as arrest. T his subsection examines hybrid items in the interview identifying the lengths of time from arrest to identification of veteran st atus, arrest to being inform ed about the PBCVTC, and from arrest to being asked about transferring the case to the PBCVTC for the interview sample (n=59) Additionally, I examine who performed these actions and at what stages they occurred (hybrid items in the interview)

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167 Being iden tified by a criminal justice agent means that an agent asked the offender about his/her veteran status. Table A 66 depicts both the time from arrest to identification and the criminal justice process stages in which identification occurred, as well as who identified the offender as a veteran. Nearly one third (31%) of veterans were identified w ithin 48 hours of arrest with 5% of these veterans being identified at time of arrest. Seventeen percent were identified between 3 days and 3 weeks (12% in the third week, 3% in the second week, 2% between 3 and 7 days). Fourteen percent of veterans reported that they were never asked by a criminal justice agent about their veteran status, and 14% cannot remember whether they were. Nearly half (47%) reported that they were identified as a veteran at first appearance (47%). Fifteen percent reported identification at booking (16%), and 14% reported that identification did not occur at any stage, which corresponds with the 14% of responses stating that identification by a criminal justice agent never occurred. The main identifying agent is the public defender (34%), followed by a judge (17%). Law enforcement and court personnel were the next most prevalent identifying agents at 12% and 10%, respectively. In concordance with previous nonidentification responses, 14% reported that no agent identified them as veterans. These veterans notified either a judge or their lawyer about their veteran status without being asked. Table A 67 lists the stage s of the criminal justice process when the veterans both first heard of the PBCVTC and were asked about having their case transferred, as well as who informed them and/or asked them to participate. Nearly half of the sample (45%) first heard about the PBCVTC at their arraignment, and sl ightly more than one third (34%) were first asked whether they wanted their case transferred at their arraignment.

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168 The public defender (31%) and a judge (22%) are the individuals who most often tell the offenders about the PBCVTC and ask about case transfer. Other stages for learning of the PBCVTC and being asked about case transfer widely varied. However, 29% of veterans reported never being asked about having their case transferred; according to the qualitative data, veterans reported that their cases wer e automatically transferred (7% first heard out PBCVTC at their first appearance in the VTC). Even though an offenders case may be transferred to VTC, it does not automatically require him/her to participate. Overall, the majority of veterans are identif ied fairly early in the criminal justice process with 62% being identified at or before arraignment (Table A 66). The frontline agents for the PBCVTC appear to be the judge and the public defender. Specifically, the public defender identified more than one third (34%) of the samples veteran status, and a judge identified 17% (Table A 66). Additionally, 31% of the sample was informed about the PBCVTC and asked about case transfer by the public defender, and 22% were informed and asked by a judge (Table A 67) However, approximately one third of the sample (29%) were never asked about having their cases transferred to the PBCVTC (Table A 67). According to policy, participation in the PBCVTC is voluntary and, if a case appears in the PBCVTC without offender permission, the veteran is not forced to participate. They must agree at their first (VTC arraignment) or second appearance (plea conference). The court session observational data confirm that this policy was adhered to for every defendant appearing for a pl ea conference or arrai gnment in the sampling frame.

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169 Early evaluation For process goal three, t he PBCVTC aims to have the participants and potential participants meet with the VJO for evaluation once they agree to participate or have stated that they are consider ing participating The data utilized were from the interview sample. Table A 68 shows that the majority of veterans (68%) were told to meet with the VJO. However, 31% (18 veterans) were never told to meet with the VJO Possible reasons for not being told to meet with the VJO could be that the veteran has decided to not participate in the PBCVTC (opt out) or that veterans new to the PBCVTC ( group 1) have not yet been told to meet with the VJO To determine whether group membership mattered, c rosstabu lations were run between group membership variables (dichotomous) and informed to meet with VJO (dichotomous). The majority of group 2 (81%), group 1 (65%), and opt outs (57%) were instructed to meet with the VJO (Table A 68) Bivariate correlations were also run between group membership variables and the informed to meet the VJO variable, but these did not produce any significant correlations. A lthough not in accord with general procedure, an alternative hypothesis is that veterans charged with only traff ic offenses may not be required to meet with the VJO. A new dichotomous variable for only traffic offenses was created, but only eight veterans from the sample were in the PBCVTC for only traffic offenses. Crosstabulations were ru n between the only traf fic offense variable (dichotomous) and told to meet wi th VJO (dichotomous) variables. However, a clear pattern did not result. Additionally, a bivariate correlation was run between these two variables and did not result in a significant correlation. Movin g further away from policy, other offense category dichotomous variables (i.e., violent, property, drug, and weapons offenses) were examined using

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170 crosstabulations and correlations but, again, no clear pattern(s) or significant correlations were produced. Reasons why these veterans were not instructed to meet with the VJO cannot be determined at this time. However, these results should be interpreted in light of the fact th at this is self reported data. Although only one veteran (1.7% of the sample) repor ted not remembering whether being instructed to meet with the VJO, t he se other veterans may not remember whether they were i nstructed to meet with the VJO but report no they were not instructed. Regarding the timing of instruction to meet with the VJO, Table A 68 shows that the majority of veterans who were told to meet with the VJO were told in the early stages of contact with the PBCVTC. The majority of those told to meet the VJO (68%) were at their first appearance in the PBCVTC, and 23 % were told bef ore they appeared in the PBCVTC. Approximately 8% and 3% were told to schedule a meeting with the VJO at their second and third appearances in the PBCVTC, respectively. Upon examination of the qualitative discussion data for both the court sessions and the team meeting, two reasons for this delay emerged. The first reason for delayed instruction was that the team deferred the case several sessions to determine eligibility (previously discussed). The second reason for delay was that the veteran wanted time t o decide whether to participate, so the case was moved to the next session. The majority of veterans (81%) did meet with the VJO, which is higher than percentage of veterans that was just told to meet with the VJO (68%). The qualitative data from the interviews show that this discrepancy ( eight veterans) resulted from the fact that these eight veterans went to talk to the VJO without being instructed to do so

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171 by the court. They were either referred to the VJOs office by other personnel at the VA or knew t he VJO prior to their case appear ing in the PBCVTC, thus speaking with her before their first appearance. Approximately 20% of veterans in the interview sample did not meet with the VJO by the time of the interview. N ot meeting with the VJO could be related to never being told to meet with the VJO or again, group membership. Surprisingly, a bivariate correlation did not produce a statistically significant relationship between being told to meet with the VJO and actually meeting with the VJO. When examini ng the relationship between group membership and meeting with the VJO, unlike the relationship between group membership and being told to see the VJO, membership to the graduate group was statistically significan t (p<.05). This relationship was negative. R easons behind why some veterans were not told to meet with the VJO remain unclear, and specific data regarding at what specific stage the veterans met with the VJO are not available at this time. The only responses available regarding when the meeting wit h the VJO took place are before first appearance, after first appearance, and do not know (Table A 68). However, veterans were overall informed that they needed to meet with the VJO during the early stages of contact with the PBCVTC, and the majority of ve terans (81%) did meet with the VJO14. Quickly link ing veterans to services based upon evaluation results To determine whether veterans are being quickly linked to services based upon the results of the VJOs evaluation (process goal four) two process centered 14 Note, per procedure, veterans who are instructed to meet with the VJO and consistent ly fail to do so in subsequent plea conference and status checks can be terminated. This may have occurred in instances outside the data collection timeframe.

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172 performance measures are examined: 1) whether the VJO is linking veterans to treatment 2) whether the treatment linked to corresponds with the evaluation results (Table A 75). In mutually exclusive items, veterans were asked whether they were diagnosed with the respective issues by the VJO and then whether they were assigned to treatment ( no discrepancies were found when the responses were confirmed later by the VJO). The veterans were also asked whether the VJO linked them to any of the correspon ding services, and the responses included no (0), yes (1), or no, already participating (2). The VJO evaluation diagnoses were previously discussed in the Interview Sample section (Table A 57), but for ease of comparison, they are relisted in Table A 69 next to the percentages of connections to service and veterans already participating in related services. The percentages between physical health (5%), benefits (2%), and transportation (2%) needs and connection to services were identical between diagnosis and connection to services as well as the percentages for those never evaluated or not diagnosed (22%) between diagnosis and connection to services The percentage of those linked to substance abuse service (39%) almost reaches the percentage of th ose diagnosed (46%), and an additional 5% were already participating in substance abuse treatment and the VJO did not link them to different treatment for substance abuse. For mental health, nearly half (46%) of the veterans were diagnosed with a mental health issues, but only 24% were connected to mental health services by the VJO. However, 14% were already participating in services and not linked to additional mental health services by the VJO. The only discrepancies between the diagnosis and connection p ercentages lie in the substance abuse, mental health, and

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173 housing areas. When the connected to service and already participating percentages are combined, discrepancies between these summed percentages and the diagnosed percentages remain for substance abuse (2% difference) and mental health (7% difference). These differences could be resulting from opt outs, and the frequencies were re run using only veterans in the opt out group. The opt out group partially contributed to the discrepancies but not entirel y accounted for the differences However, the percentages are mere descriptives of these items, and relationships between diagnosis and linkage need to be determined. Crosstabulations and bivariate correlations were run for diagnosis of mental health, substance abuse, and homelessness and their respective connection to mental health treatment, substance abuse treatment, and housing services. T he crosstabulation results are depicted in a contingency table (Table A 70). The majority of veterans that are diag nosed with substance abuse, mental health, or homelessness appear to be connected to the appropriate services. Further, bivariate correlations revealed that the diagnosis of a status (i.e., substance abuse, mental health, and homel e ssn ess) and the connecti on to the appropriate services (i.e., substance abuse treatment, mental health treatment, and housing services) were each highly correlated at .80 and each highly statistically significant (p=.00). Only a small number of veterans were diagnosed with subst ance abuse issues (four veterans) or mental health problems (three veterans) but were not connected to those respective services. Reasons for these failures cannot be determined from the data available. However, most are being connected to the appropriate services, meaning that the PBCVTC is largely achieving this process goal.

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174 Ongoing interaction between judge and participants Ongoing interaction between the PBCVTC judge and its participants is the fifth process goal. The judges primary contact with the v eterans occurs in court, so hybrid variables relating to frequency of court appearances in the interview data were utilized. All veterans in the sample were asked in a hybrid item how often they were currently appearing in the PBCVTC (did not apply to opt out and terminated groups). Veterans in groups 2 and graduate were also asked in a hybrid item how often they appeared in the beginning of the their participation. Group membership was also examined because an incentive for consistent compliance is fewer c ourt appearances, so the data should indicate that veterans in groups 2 and graduate appear less frequently than those in group 1. Crosstabulations in Table A 72 show the breakdown of frequency of appearance by group. New participants appear in court at least once a month. Nearly half (45%) of new participants (group 1) appear once a month, and group 2 (69%) and graduates 40%) also mostly appeared once a month when they began the program. More frequent appearance also appear common for new participants with 30% of group 1 appearing more than once a month (15% once a week, 15% bi weekly), and 20% of graduates and 8% of group 2 appearing bi weekly when they began. Moving to group 2s current appearance rates, most appear either once a month (42%) or once every other month (35%). All graduates (100%) reported that they appeared once a month during the months before graduation. Overall, most new veterans (75% of Group 1) appear a minimum of once a month, and a drop is seen in frequency for Group 2 (81% appearing a minimum of once a month in the beginning to 42% appearing only once a month) Once a month

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175 appearances are the most popular appearance rates for all groups. I believe this is an acceptable rate as it allows for veterans to both routinely appear before t he judge and show compliance. Many of the treatment sessions are weekly or bi weekly, and a monthly appearance allows a compliance record of three to four weeks to be established for the team members to use in their decisionmaking process. Once a week and bi weekly appearances for group 1 are attributed to placing the case on the following weeks docket to allow the veteran to meet with the VJO for evaluation and report to the team the following week or to allow a veteran time to decide on participation. O ngoing interaction between veterans and mentors Process goal six holds that ongoing interaction between the veterans and their mentors should be occurring F orty one percent of the interview sample had mentors (n=24) Veterans with mentors were asked in cl osed item s (yes or no dichotomous response) whether they met with their mentors in person, talked to their mentors on the phone, and communicated electronically with their mentors. They were asked about the frequency of these behaviors in openended it ems. Veterans who had multiple mentors (i.e., current and previous) were asked all of the aforementioned items for each mentor. Table A 73 illustrates the number of veterans that meet with their mentors in person and/or communicate via phone and/or electr onically, as well as the frequency of the communication. Twenty one veterans had mentors at the time of the interview, and three of these veterans had mentors before being assigned to their current mentor. The primary methods of communication are the phone and face to face meetings for veterans with their current mentors, as well as veterans with their previous mentors Meetings appear to mainly be once a month (43%), which may coincide with appearing

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176 in court. More than on e quarter (28%) of veterans meet w ith their mentor more than once a month ( 5 % three times a month, 10% bi weekly, 10% weekly, 5% several times a week ). Communication via phone occurs more frequently with 81% of veterans with mentors speaking with their mentors more than once a month (38% bi weekly, 38% weekly, 5% several times a week). Electronic communications s uch as text message and email were only used by four veterans with mentors, making it the least utilized method of communication. This could be related to the age of the sample. Fre quency of electronic communication ranges from several times a week to once every 4 months. Overall, communicat ion appears to occur fairly frequent, but specific communication frequency is not stipulated by the PBCVTC. However, less than half of the sampl e (41%) has been assigned a mentor despite it being a specific process goal of the PBCVTC and one of the 10 tenets of VTCs. When mentors are assigned the communication appears frequent. B ut with the majority of the sample lacking a mentor, the PBCVTC has not fulfilled this process goal. Organization and agency partnerships Process goal seven is the collaboration of the agencies identified in case study one, which are relisted below. Judiciary in the Fifteenth Judicial District State Attorneys Office Pub lic Defenders Office Clerks Office Comptrollers Office PRIDE Probation Department of Corrections Probation Court Administration VA Stand Down House Vietnam Veterans of America

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177 Law Enforcement Administration For all agencies with the exception of the Co mptrollers Office, I was able to directly observe the collaboration of all agencies t hrough the s tructured observations and data collection for case study one, and I recorded the presence and participation of all agencies in team meetings and court sessions with the structured observations ( seven team meetings and eight court sessions) Although I was unable to directly observe the Comptrollers function within the inter agency partnership, the Comptrollers Office pays the court personnel, funding the agencies, which can be deemed as participating and facilitating collaboration. For all other agencies, the structured observations showed that these agencies did work together for the PBCVTC to function during the data collection period. No agency failed to collaborate during the observation period. During the data collection period of studies one and two, the judiciary of the Fifteenth Judicial District presided over every court session and appeared in every team meeting. Additionally, the assistant district attorney (ADA) and the public defender attended every court session and team meeting during data collection for studies one and two. I was made aware of two sessions prior to th e data collection for study one where Judge Booras, the PBCVTC judge, was out of town for three sessions, but another judge (also a veteran) from the Fifteenth Judicial District presided over the PBCVTC in Judge Booras absence. Additionally, clerks and bailiffs were present at every court session during the data collection for studies one and two. Other team members were absent for team meetings and/or court sessions. The DOC probation officer was present at every court session; he was absent during one

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178 team meeting but sent a representative who did supply all the necessary data for the team meeting. The PRIDE probation officer was present at every court session, but she missed one team meeting and neither sent a representative nor the information to any other team member. The mentor coordinator (Vietnam Veterans of America) missed four of the seven team meetings and neither sent a representative or any information to another team member. The mentor coordinator missed two court sessions and did not send a representative. The community treatment provider attended every team meeting during data collection for studies one and two, but he missed two court sessions during the structured observations. The VJO assigned to the PBCVTC missed three team meetings and three court sessions but she sent a VA representative with some information pr ovided. Regarding participation in team meetings and court sessions, all team members were vocal to varying degrees. However, the concern here is whether they all participated when present, which they did. The degree to and manner in which they participated are addressed in the next subsection (process goal 8). In both the structured observations and data collection for study one, the various providers fulfilled their service roles. Specifically, the VA provided medical care, mental health services, housin g services, transportation services, and substance abuse treatment to qualifying veterans. Community treatment providers provided mental health, housing, and substance abuse services to veterans inelgible for VA services and services not provided by the VA to VA eligible veterans. Vietnam Veterans of America provided the mentoring services. Both probation services (DOC and PRIDE) and the VJO provided supervision services. The Fifteenth Judicial District, Court Administration,

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179 State Attorneys Office, Public Defenders Office, Clerks Office, and law enforcement make the legal proceedings possible. No agency refused to fulfill their roles and collaborate in the function of the PBCVTC. However, r egardless of whether information was relayed to substitutes, the absence of certain members affected the process more than the absence of others. The qualitative data revealed that the absence of the VTC assigned VJO was detrimental to the process even though a VA representative was provided. The representative was miss ing nearly all treatment compliance and VJO meeting compliance information that were necessary for fully informed decision making by team. Other team members were visibly frustrated, and many of these cases had to have to be determined decisions and set for a st atus check on a future docket. Additionally, my ratings of the VJO substitute for being knowledgeable ranged from not at all to somewhat on the fivepoint Likert scale, as well as affected ratings for those particular team meetings in terms of fairness of the recommendations and evaluations. In contrast, the mentor coordinators absence did not negatively impact the discussions and decisions because so few veterans are assigned mentors, and the mentor information is generally supplemental to the compliance information. The presence of the judge, ADA, public defender, probation, and VJO are determined to be necessary for the PBCVTC to operate appropriately. Without these key players, the necessary representations are not met and decisions either c annot be made or will be made based on partial information. VTC team working in nonadversarial manner The data from the structured observations are used to determine whether p ro cess goal eight PBCVTC team (i.e., judge, ADA, public defender, VJO, probation, mentor coordinator, and community treatment provider) working together in a non-

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180 adversarial manner has been achieved. In the team meeting structured observation, levels of confrontation of the meeting overall and of each team member were recorded using four point Likert scaled item s ( not at all, somewhat, mostly, completely ) for the level of confrontation overall and then for each team member. Additionally, an open ended item for the reason(s) why each confrontation score (i.e., overall and individual) w as assigned. Levels of reserve and involvement were also gathered at the individual level utilizing the same four point Likert scale and openended items. Further, an openended item for n arrative comments allowed for additional information to be included In the court session structured observation, levels of confrontation at the individual level were recorded again, using the same four point Likert scale and openended items. Levels of confrontation between the team members and the veterans were recorded, utilizing the same format. An openended item for a dditional comments at the end of the instruments allowed for the inclusion of supplemental information These structured observation instrument sections were completed immediately after the respective tea m meeting and court session concluded. For the team meeting s, the average confrontation score and individual level percentages in Table A 77, and the average confrontation scores and individual level percentages for court session confrontation levels betw een team members are located in Table A 8015. Overall, the average confrontation level of the team meetings was a 1.57, which is between not at all (1) and somewhat (2). In the team meetings, t he most confrontation al team member was the ADA with an average rating of 1.71 (Table A 77) 15 A second public defender is listed in Table A 80. She is solely in charge of veterans with onl y a drivers license or DMV infraction(s) and is present at the court sessions but not the team meetings. These offenders are not participating in treatment, and she provides the court with updates during the PBCVTC sessions.

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181 and the second most confrontational team member was the public defender with an average confrontation score of 1.57 (Table A 77) These were the most confrontational members in the court sessions as well, with the ADA having an average score of 1.87 and the public defender averaging a 1.50 (Table A 80). According to the qualitative data, disagreements in the team meetings emerged solely between the ADA and another team member. Confrontation mainly occurred between the ADA and public defender during discussions of noncompliance or whether to offer participation in the PBCVTC to a potential veteran participant. Other disagreements during team meetings included the ADA against the judge, public defender, and/or probation regarding the interpretation of violations (i.e., probation or contract violations) Over the course of the eight observed court sessions, the qualitative data indicate that the public defender and the ADA had noticeable disagreement s in three court sessions. Each of these three, featured multiple moments of disagreement. In one observed session t he DOC probation officer openly disagreed with a decision made by the ADA to terminate a participant Team meetings and the court sessions produced generally identical or very similar confrontation scores for the individuals observed. In several cases including the VJO, community treatment p rovider, and mentor coordinator there were no open disagreements or confrontations in either team meetings or in court For the ADA, th e average confrontation score was slightly higher for the court session ( 1.87) than in the team meeting (1.71) However, other team members were modestly more

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182 confrontational in the team meeting than in court, including the public defender (1.57 versus 1.50) PRIDE probation ( 1.16 versus 1.00 ) Table A 78 displays each team member s reservation level in the team meetings Reservation levels indicate the frequency with which a team member appears to be withholding an opinion. In four of the seven team meetin gs, it appeared that all members were able to express themselves freely and without obvious reservation. O n one occasion, the PRIDE probation officer indicated to the team that she would not comment because their decision was already made, a decision which followed a lengthy disagreement between the ADA and other team members. At three team meetings, the public defender, following extended disagreement with the ADA, lapsed into a position of resignation declining to press arguments further ( see below ). Ta ble A 79 depicts each team members level of involvement. Levels of involvement were assigned based on how much each member participated in the team meeting (e.g., provided information, opinions, speculation, and answers). Team members achieved high levels of involvement. The judge received a 3.85 average participation score which is high but lower in comparison to other team members (i.e., ADA, public defender, VJO, and DOC probation) because, in one meeting, he did contribute to discussion but left early missing the last three cases on the docket. PRIDE probations involvement increased over the sessions, and I believe this occurred because she was the newest member on the team. The function of the VTC not only present s the possibility for confrontation to occur between team members but also produces the possibility for confrontation between team members and veterans appearing before the VTC. Thus, I also assessed

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183 confrontation levels between each team member and the veteran participants ( Table A 81) Co nfrontation levels are, again, low with the ADA being the most confrontational with an average score of 1.62. However, the judge is the second most confrontational member with an average confrontation score of 1.37, followed by the public defender at 1.25. The public defender devoted to DMV infractions received a confrontation score of a 1.14, while the rest of the team members were not at all confrontational with the veteran participants. Although the confrontation levels appeared low, t he qualitative dat a revealed that the sources of confrontations between team members and veterans were variable and unpredictable. In one case, judge wouldnt be swayed by veteran(s) whose story did not match the info he had in front of him and made it known that he did n ot appreciate being lied to by part icipants. The judge also instructed one verbose veteran to stop talking. In a third instance, the judge ordered one veteran removed from the audience for talking during the proceedings Additional confrontations arose bet ween the ADA and a veteran when she was unwilling to reduce some requirements although other team members and the veteran were pushing for it and when she did not take additional information into account when provided by team members and a veteran. The p ublic defender and his client also had a confrontation because his client would not stop talking slightly different than the confrontation between the judge and the verbose veteran in that public defender had to become confrontational with his client to help the veterans cause. Overall, team members charged with determining whether veterans would be offered participation or whether they were compliant displayed low levels of

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184 confrontation and reservation and high levels of involvement. Although confrontat ion levels differed for some members between team meetings and in court, overall confrontation levels were low (all below somewhat (2)) and team members did treat each other respectfully Members were generally not reserved and spoke when they felt it nec essary. All team members were very involved (with PRIDE probation becoming more involved as the meetings progressed). Generally, the team member and veteran interactions were positive. On occasion, as previously discussed, there were some contentious moments, but even in these moments, veterans were generally handled respectfully. The overall feeling was that team members were friendly and respectful to the veteran participants. Although the observations yielded low levels of confrontation, they did reveal an interesting result regarding the dynamics of the VTC team. I anticipated witnessing the judicial role being the most powerful, but the ADA appeared to wield the most power in the group. In all matters of contention, the judge would defer to the ADAs decision. I believe public safety is the reason for this power dynamic Case Study Two Conclusion Utilizing structured observations of team meetings and VTC sessions and participant interviews, this section presented the first implementation case study of a V TC. This study identified eight major process goals central to the effective implementation of the PBCVTC (Table A 75). The implementation case study both revealed the PBCVTC achieved notable implementation success es and identified some areas in need of im provement. Notable implementation successes were related to the target population (goal one) connection to services (goal four) judicial interaction with the veterans (goal 5)

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185 agency partnerships (goal 7), and nonadversarial nature of the team (goal 8) The PBCVTC was obtaining its target population and quickly linking them to the appropriate services. Cases where they were not linked to services were very infrequent. Additionally, the frequent court appearances mandated did produce the desired frequenc y of interaction between the PBCVTC judge and its participants. From the observations, agencies collaborated willingly and appropriately. Overall, the team members did work together in a nonadversarial manner, and in the instances w h ere confrontation occurred, all members involved treated one another with respect. Early identification (goal two) and evaluation (goal three) did occur for the substantial majority. However, these numbers could be improved. To improve early identification, s ystematic screenin g of offender s for veteran status is recommended. Veteran status identification could be formally incorporated in both the booking and arraignment procedures, standardized across intake facilities and courtrooms in the Palm Beach County. To improve early evaluation, further information is necessary to determine who is not being evaluated and why and this should be the inquiry of future study to understand who is being excluded from evaluation and why The mentoring component (goal 6) fell significantly short of the objective If mentors are not assigned, participants cannot have frequent contact with them. This failure is linked to the overarching conclusion from t his implementation case study: t he PBCVTC is lacking policy in several important areas. The PB CVTC does not have a set procedure for which veterans receive mentors. It is not defined by policy, and the team members were unable to answer this question when asked individually.

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186 Furthermore, the PBCVTC does not have set program phases for veterans to move through nor does it have a specified reward/sanction application system. Because these policies did not exist, they could not be examined. However, the PBCVTC should create policy in these areas to allow for further evaluation of implementation and fu ture studies of impact. Overall the PBCVTC has been achieving most of its process goals One reason behind this general success may be the agreement between the team members on the mission of the PBCVTC and the problems of its participants. All members did believe in a relationship between military service, issues, and criminal justice contact for most offenders and wanted to address the underlying causes of contact with the system. However, although she did believe in this relationship, she was less cons umed by it than the rest of the team. This could be due to several reasons. First, she is civilian and not a veteran. The only other civilian team member is the VJO, who works at the VA and may have a greater level of sympathy based upon her experience at the VA Medical Center. Second, it could be contributed to the role of the ADA. As evidenced in the findings, the ADA was the most confrontational member of the team, and most conflict occurred between the ADA and public defender. These team members have a common goal (to rehabilitate veterans to reduce future contact with the criminal justice system) but also have additional goals based upon their roles (i.e., the ADA must protect the public and the public defender must advocate for the offender).

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187 CHAPTER 5 INTEGRATIVE FINDINGS AND FUTURE RESEARCH Overview Treatment oriented courts are, almost by definition, highly self conscious in articulating formal mission statements and goals. In part, this reflects the need for jurisdictions to justify the investment of time and resources in the nontraditional processing of criminal offenders. While an extensive literature points out the gaps between mission/goals and actual practice in such courts, it is also true that the articulated purposes of treatment oriented c ourts are thought to exert consider able influence on participants. For further e xploration it is useful t o examine the mission statements ; conceptualizations of service, requirements, and eligibility ; and implementation of the PBCVTC with in the national cont ext. This chapter integrates the findings from the national survey, indepth case study, and previous research in related areas, which reveals that treatmentoriented courts develop highly distinct approaches to conducting business. From these examinations I have identified additional challenges faced by rapidly diffusing institutions and recommendations for future research, which are subsequently discussed This chapter concludes with a reflection on the importance of the research in this area. Mission a nd Goals In the most general terms, t he PBCVTC s mission is consisten t with that of VTCs nationally The PBCVTC seeks to reduce recidivism, which is the most commonly reported mission goal in the national survey (Table A 14). Additionally, the PBCVTC shares with its national peers their most specified gen eral target population: veterans in contact with the criminal justice system (Table A 16). The universality of both the

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188 mission and the target population among VTCs are a reminder that, regardless of the degree to which treatment oriented courts focus on providing specialized services, their primary rationale and justification remain the need to respond effectively in nontraditional ways to criminal behavior. Conceptualization The PBCVTC also has the second most reported objective nationally, which is to provide treatment services (Table A 15). However, it is the manner in which the court conceptualizes those services, considers mechanisms for service delivery, and identifies the specific targets for court intervention where the PBCVTC deviates from its peers. The PBCVTC conceptualizes its services in a broader manner than its peers. The PBCVTCs p rocess goal within its mission of addressing the underlying health and psychosocial problems of veterans corresponds to the national samples process goal to address veterans complex issues a goal found in only 4% of responses (Table A 14). While the PBCVTC does offer the same treatments and services that most of its peers offer (i.e., mental health and substance abuse treatment and housing, vocational, and transportation services), the PBCVTC offers additional services that most VTCs do not. The PBCVTC offers the full spectrum of services to address the broad definition of psychosocial problems to its participan ts (i.e., aid in obtaining a valid drivers license, fulfilling DMV requirements, and claims/benefits assistance to medical care and inpatient mental health and substance abuse treatment services). In keeping with the PBCVTCs broad concept, the program off ers a comparatively broad spectrum of service delivery. In addition to the most common elements (i.e., mentor coordinator tasked with mentor assignment, the VJO and ADA

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189 screening for eligibility, the VJOs initial evaluation, and the weekly team meetings a nd court sessions) and areas of evaluation (i.e., mental health, substance abuse, trauma exposure, physical health, family relationships, social support, housing, employment, and education) of VTCs nationally, the PBCVTC is, again, more inclusive than its peers. The PBCVTC also assesses military and VA status, benefits, transportation needs, and medication histories The requirements for participation and graduation are also more comprehensive than its counterparts. Similar to most VTCs, the PBCVTC require s participation in treatment and frequent court appearances, as well as pleading guilty and going on probation in certain cases. In addition, the PBCVTC mandates random urinalysis, medication level testing, and a diversionary plea agreement in certain cases To graduate, the PBCVTC and its peers require the veteran participants to complete all treatment requirements and fulfill al l court mandates (including probation where required) but the PBCVTC team must also unanimously agree the veteran is ready to grad uate (slightly less than half of its peers also have this requirement). Although the target populations indicated in the formal mission statements are broad both across the country and in the PBCVTC, the actual populations targeted are more defined and less inclusive upon examination of the eligibility requirements (Chapter 3) However, even on review of the eligibility requirements, the PBCVTC is still more inclusive than the national norm because it has only two very specific charge exclusions: 1) homici de category 2) rape category. Conversely, its peers tend to be more exclusive in terms of their target populations and eligibility. For example, nearly half of VTCs in the national sample require participants to have an honorable discharge status, and near ly half exclude any type of violent felony charge. Additionally, charge

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190 differences existed between the groups of veterans served nationally and by the PBCVTC. Drug charges were more prevalent in the national report, and traffic charges were more prevalent in the PBCVTC. The charge differences discovered could be a function of the eligibility requirements and case acceptance. Some VTCs across the country specify the participant must have a substance abuse issue, and the PBCVTC is one of the only VTCs in the country that allows participation for traffic infractions. When examining the PBCVTC within the preliminary findings in the typology, the PBCVTC could be considered an all purpose and treatment oriented VTC because of its comprehensive conceptualizat ion of services, service delivery, and target population and extensive amount of services offered. The diverse population serviced by the PBCVTC due to its highly inclusive nature (few exclusions for participation) call s for it to fall under the all purp ose court group as opposed to in the creaming court group. The PBCVTCs treatment oriented designation in lieu of the management centered group membership stems from the wide variety of services offered ( i.e., they outnumber its supervision means). Addi tionally, although the variable was not included in the cluster analysis because the majority of VTCs utilize one, the PBCVTC does lack of a set reward/sanction ladder. However, VTCs could be acting in strict managerial sense without this set reward/sancti on system, so to explore this possibility, I compared the noncompliance statuses with termination decisions in the observation sample. While 31 noncompliance determinations were made in the seven team meetings, only three termination decisions were made. T his observation shows that the PBCVTC does not automatically proscribe termination for noncompliance, indicating that they allow for

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191 relapse to occur, which coincides with the medical model (a more therapeutic model of addiction). It is important to real ize that the purpose for eligibility requirements was not explored; thus, the all purpose and creaming designations refer to operation and not directly to intention. Although many VTCs exclude veterans with VA inelgibile veterans, this exclusion may not be indicative of an attempt to obtain participants with a higher likelihood of success (creaming). This exclusion may be in effect due to ability to provide services. VA ineligible veterans do not receive VA benefits and must receive services outside the VA, which may not be available in all jurisdictions and/or add an additional layer of challenges to certain courts. Implementation Researchers must test i mplementation fidelity for several important reasons. First, outcomes cannot be accurately interpreted w ithout knowledge of the implementation of the intervention in question. How an intervention or aspects of interventions (e.g., adherence to policy or innovation/deviation) are delivered may positively or negatively affect program results. Second, and simil arly, theories asserting the importance of different components of an intervention cannot be tested without knowledge of the administration of each. Third, ongoing evaluation of implementation allows for the early identifi cation of application problems a nd their qui ck corrections (Durlak and DuPre, 2008) Although many agree on the importance of the influence of implementation on outcomes, implementation has not been a primary focus in the study of programs and interventions. Numerous studies aim ed at as sessing outcomes exclude examination of implementation. For example, of 1,200 mental and physical health and education

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192 prevention studies before the end of 19 95 only 5% had data on the programs implementation (Durlak, 1997). For 162 mental health prevention studies between 1980 and 1994, only 24% (39 studies) tried to record implementation, and only 8% (13 studies which were included in the previous 39) examined whether implementation affected program outcomes (Dane and Schneider, 1998). Only nine of the hundreds of drug prevention outcome studies in a 25year period reviewed by Dusenbury et al. (2003) discussed the relationship between outcomes and implementation. To assess the e ffect of implementation on outcomes, Durlak and DuPre (2008) conducted fiv e meta analyses of quantitative and qualitative studies between 1976 and 2006 on child and adolescent prevention and health promotion programs related to drug use, physical health, physical development, academic performance, social issues, and mental healt h issues. In the five metaanalyses, there were 483 studies and an additional 59 studies that examined the e ffect of implementation on impact Durlak and Dupre (2008) found that implementation matters. I mplementation determines outcomes in that the level of implementa tion achieved affects the outcomes of the program. Achieving good implementation statistically increases program success and results in stronger positive results for participants (Durlak and Dupre, 2008) Although VTC program outcomes are extremely important, implementation must be ascertained before outcomes can be fully assessed. This dissertation research acknowledges the i mportance of implementation with the inclusion of an implementation case study of one of the early VTCs, the PBCVTC (Chapter 4) a nd items addressing implementation in the national survey (Chapter 3) Several implementation achievements (i.e., conflict management and collaboration with service providers/VA)

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193 and challenges (i.e., graduated system of rewards and sanctions early identi fication and evaluation and mentoring) identified by the case study can be examined within the national context Graduated System of Rewards and Sanctions The majority of VTCs nationally had either some type of graduated system of rewards and sanctions t hat correspond to certain behaviors (reward/sanction ladder) or a set of program phases through which participants would progress. While most VTCs will be able to assess whether these applications or phases are implemented properly, the PBCVTC does not hav e an explicit reward/sanction ladder or program phases. This absence makes it difficult to examine whether participants are being treated the same throughout the program. As previously recommended, t he PBCVTC should create policy in these areas to allow for further evaluation of implementation and future studies of impact (VTC Research: The Next Steps). Early Identification and Evaluation Although early evaluation is listed as one of Russ ells 10 key components of VTCs, not a single VTC in the national sur vey listed early evaluation as a process goal or an objective in their mission statements. However, in action, the PBCVTC did want to identify and evaluate veterans in the early stages of case processing. Overall, the PBCVTC did evaluate the majority of their veterans early. For those that were not evaluated at all, a clear or statistically significant pattern or profile of who m was not evaluated did not emerge. Thus, the PBCVTC was not systematically excluding a particular group or profile of veteran from evaluation. Evaluation is supposed to be a part of the VTC process for all veterans. It should be the inquiry of future

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194 implementation studies in all VTCs and further explored in the PBCVTC (VTC Research: The Next Steps). Mentoring Although the PBCVTC app ears to be more comprehensive than its peers, it shared one notableand surprising deficiency identified in the national survey, the mentoring component. Like most of its peers, the PBCVTC does have a mentoring component, but also like most of its peers, i t does not require participants to have mentors. This was a surprising finding both nationally and at the case study level, since mentoring is one of the 10 key components of VTCs. One way in which the PBCVTC could further fulfill its comprehensive treatme nt goals would be to incorporate mentoring into its mandated treatment plan. Further research might explore the basis for what appears to be the most striking implementation problem of both nationally and Palm Beach County (VTC Research: The Next Steps). Conflict and Collaboration Russells component of working together in a nonadversarial manner (a trademark of specialized courts) is generally achieved. In the national survey and the case study VTC team members cooperate and communicate effectively in a nonadversarial manner The case study provided a more indepth picture of dynamics within the VTC team. From the case study, it is evident that confrontation does infrequently arise, and in the instances where confrontation occurred, all members involved treated one another with respect. One reason behind this general success nationally and in the case study may be the agreement between the team members on the mission of the VTC, the problems challenging its participants, and the relationships between problems and military service in its participants.

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195 When conflict did arise in the PBCVTC, it always involved the ADA. Although the observations did not characterize the PBCVTC ADA as unsupportive, several VTCs across the country reported an unsupportive pros ecuting attorneys office as a challenge. Several VTCs also suggested changes they would like to see in the prosecuting attorneys attitude, specifically a decrease in the prosecutorial attitude and an increase in the nonadversarial dynamic between the prosecuting attorney and the VTC team. This conflict between the District Attorneys Office and the rest of the VTC may be contributed to the prosecuting attorneys purpose. VTC team members, including the prosecuting attorney, have a common goal (to rehabilitate veterans to reduce future contact with the criminal justice system), but the District Attorneys Office also has additional purpose protect the public. The District Attorneys Offices main goal is promoting public safety, and in certain instances, the actions to protect this interest may conflict with those of treatment and rehabilitation. Future research should examine the tension between the District Attorneys Office in specialized courts (VTC Research: The Next Steps). While no issues between the VA service provider and the PBCVTC were evident, VTCs across the country reported experiencing problems with the VA as a service provider. Challenges reported included long wait lists for services, communication issues, noncooperation, lack of needed r esources, and suspension of services while veteran is incarcerated The relationship and dynamics between the VA and VTCs need to be included in the areas of focus in future implementation studies (VTC Research: The Next Steps).

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196 Additional Challenges for a Rapidly Diffusing Institution In approximately 4 years (January 2008 to November 2012), 114 VTCs were established and began o perating in 32 states. As of November 2012, 18 VTCs were in progress of being established in nine states with other areas gaining support. Similar to the rise of drug courts, VTCs appear to be quickly spreading and rapidly gaining support across the country without any systematic assessment VTCs will continue to spread before any additional research can be conductedcertainly befor e outcomes can be adequately assessed. Because of t he absence of an evidencebased VTC model or VTC practices, program creators and administrators must carefully conceptualize their program components and focus on effective implementation. VTCs, and all spec ialized courts, face specific challenges that stem from their rapid rise in response to q uickly evolving problems. Two main challenges are changing populations and funding. Changing Populations Drug courts and VTCs were created and spread rapidly in times w hen their populations were fluid. Drug courts were created to decrease addict populations; however, addict populations were changing, constantly presenting new challenges. Drug courts have had to handle shifts in available substances, use, and population, and VTCs will have to similarly adapt to the fluidity in their population. VTCs nationally have reported recent shifts in their populations in the areas of era of service (and age), sex, and emergence of issues. Era of service and age Although veterans from many eras have been in the population for several decades and t he VTC concept is based on the understanding and research focusing on t h ose veterans VTCs have emerged during the OIF/OEF/OND era. Much research on

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197 Vietnam veterans has informed our understanding of servicerelated problems, but the significance of the Vietnam era is currently declining as seen in the national survey. Although the Vietnam era was the most prevalent era of veterans in the PBCVTC, the OIF/OEF/OND era was most reported nationally. Nationally, VTCs reported changes seen a decrease in the age of veterans in contact with the criminal justice system with the increase of veterans from the most recent era of service. Although, t he PBCVTC has an older s ample of veterans that is more congruent with the national veteran population and not the national VTC participant population, which is younger, it will eventually have a population more similar to VTCs nationally as more OIF/OEF/OND return to the area and older v eterans phase out. Time and future research will determine whether different services will be required for this new era of veterans, and VTCs will need to adapt to their changing population. Increase in female veterans The PBCVTC and VTCs across the count ry have reported increases in their female veteran population. Female veterans have participated in combat for decades and many injuries are not combat related. However, m ore females are serving in the military today than previously and in January of 2013, the ban on females serving in w as removed. D ue to these recent changes combat experience and its rel ated injuries a re anticipated to increase i n the f emale veteran population Female veterans may face different challenges than male veterans, and VTCs will need to adapt to serving more female veterans. For example, my research revealed differences b etween the sexes in issues faced and offense types as well as differences in the degree of difficulty in meeting certain VTC requirements. With the increased percentage of females in the military (regardless of combat class ification), t he needs of

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198 the female veterans need to be further assessed for appropriate service and treatment application. Delayed onset Although homelessness has traditionally been the most publicized issue facing veterans, substance abuse and mental health issue s were the most reported issues facing veterans bot h nationally and in the PBCVTC. S ome VTCs across the country require a substance abuse and/or mental health diagnosis for participation or a relationship between these issues and the offense, which would increase the prevalence of these issues in their VTCs However, t he PBCVTC does not and substance abuse and mental health issues are still the most prevalent problems Additionally, VTCs nationally have reported an increase in the number of veterans they see with substance abuse issues. I predict that the PBCVTC will see an increase in the number of substance abuse and mental health issues in their participant population based upon the current anticipated influx of veterans from the OIF/OEF/OND era and the literature on the delayed onset of these issues (Chapt er 1 and Chapter 2). Because mental health and substance abuse issues may not surface immediately, sometimes decades after service, VTCs may provide early intervention by being less exclusive in their eligibility requirements. The PBCVTC deviates from its peers in its inclusivity; it is highly inclusive. A lthough the PBCVTC may allow veterans charged with innocuous offenses (e.g., traffic offense) to participate, they may be unknowingly providing early intervention to many veterans whose issues may not hav e surfaced yet.

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199 Funding for Services During the early popularization of drug courts, federal funding was provided. Eventually, federal funding diminished, but drug courts survived in the absence of federal funding. One reason for their survival is related to the fact that their treatment services are provided by community and non profit treatment agencies with which the court partners. Often, the participants are paying fees for service. With the recent and proposed cuts to veterans benefits, VTCs should be begin preparing survival strategies Currently, most VTCs operate within their own court jurisdiction s funding allocations, but the services are primarily provided by the VA (federally funded) which may be why most VTCs require VA eligibility for partici pation. This is where VTCs differ from drug courts, and diminished federal funds may be more problematic for VTCs. As seen in the national survey and case study, most services are provided by the VA and many services are al so provided by nonVA agencies. I n VTCs that accept them, VA ineligible veterans go to nonVA treatment provides and pay fees (often reduced fees) for services rendered. In light of federal funding cuts, t he funding problem aris es with the VA eligible veteran s. The VA services VA eligible veterans. Additionally, if a VA eligible veterans needs services the VA does not offer, the VA pays for the VA eligible veteran to receive services f rom a nonVA treatment provider. VTC Research: The Next Steps Due to their recent emergence, VTCs are an understudied phenomenon. Although new in terms of the age of specialized c ourts, VTCs have already diffused nationally despite any form of systematic evaluation or creation of evidencebased policy or model(s). Little is known about VTCs in general, and this study has begun to fill this gap in knowledge. Although much was discovered in this exploratory study, many

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200 questions still remain (and have emerged) and various facets were not explored either due to the limitations or scope of this study. I have identified four major substantive areas for future research in the VTC arena, including multisite comparisons, intermediate outcomes, mechanisms of diffusion, and theoretical inquiry. These four areas are detailed in the following subsections. Multi Site Comparisons Although they have not been conducted to date, VTC research should expand t o include comparative studies. Building upon my implementation case study, I have begun organizing two comparative case studies. The first involves my implementation research and the nearly completed implementation research of two researchers in Texas ( i .e., Houston and San Antonio). Second, I am in the process of obtaining approval for a VTC study in Pulaski/Perry County, Arkansas, where I plan to replicate my current case study. With these multi site comparison studies, I aim to ascertain adherence t o national standards and an understanding of critical implementation issues, a s well as refin e a VTC typology. Similar to the 10 key components for drug courts and for mental health courts, the 10 key components for VTCs are vague and deficient in areas such as ex planations of operation, implementation, and evaluation. Furthering the discussion of the national adherence to the 10 key components, researchers should further explore their usage and compare them with those of the drug courts and mental health c ourts. Research should also examine their purpose and lack of specificity across all three specialized courts, including benchmarks and specified procedure. To further understand implementation success es and challenges, as well as reasons for e ach various components, functions, and operations of these VTCs must

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201 be compared. Specific cross site comparison areas of focus should include implementation; levels of conflict, the power dynamic within the VTC team, and conflict resolution; reward/sanction ladders and program phase progression; relationship and dynamics between VA and the VTC; population and changes in population and population needs; services and treatment offered; and funding. Additionally, mentoring should be explored in depth across sites, as this was one of the primary implementation issues in both the national survey and the PBCVTC. The construction of a typology would benefit future research, specifically by aiding in the assessment of outcomes and comparative study, as well as help in moving t owar d the creation of an evidencebased VTC model(s). Although the cluster analysis did yield some interesting results in this study, the exploration of a VTC typology should be further pursued (Chapt er 3). Research should incorporate additional variables (e.g., number of terminated veterans ) variable combinations in the data from the national survey, a nd data that could be obtained (e.g., rates of noncompliance determinations ) Because age of the VTC is highly related to the size of the VTC, other variables p oten t i ally related to the court size should be determined, obtained, and tested. Further, more information on mentoring should be obtained and examined within the typology exploration. Intermediate Outcomes The national survey and c ase studies primarily focused on the existence, characteristics, and implementation of the VTCs and did not d etermine impact. Although no studies have appeared to date examining these outcomes, I have designed my study from the beginning to measure out comes. I have already begun an initial intermediate outcome case study. The goal is to understand what early effect(s), if any, the PBCVTC

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202 has on its participants. Specifically, the larger intermediate outcomes case study was devised to answer the research questions listed below. Ar e the impact goals (e.g., improved relationships, gaining employment, abstinence from substance abuse, not violating probation, participating in treatment) currently being achieved and, if so, to what extent? Have other changes in behavior occurred in the veteran participants? Have veterans changed their perceptions of the PBCVTC, the PBCVTC personnel, their level of responsibility, and/or their issues/diagnoses? IRB granted approval for follow up interviews on September 20, 2012 (#2012U 963)16. I contacted the previously interviewed veterans (n=59) and conducted 6month follow up interviews from November of 2012, through January of 2013, resulting in a W ave II sample of 47 veterans (80% of the original sample). These veteran participants were either still p articipating in, had graduated from, were terminated by, or had dropped out of the PBCVTC. The 6month follow up interview instruments were comprised of closed, hybrid, and openended items addressing the following areas: Demographic changes Military exper ience and status changes Current legal charges Previous legal charges and criminal history (last 3 months) VTC process and agents Mentoring Other services and court requirements Housing status, history, and programs participated in Substance abuse status, history, and programs participated in Mental health status, history, and programs participated in Rather than to prematurely discuss 6month findings, I hope to also conduct 12month and/or 24month follow up interviews to achieve a richer picture of intermediate impact and evolution of participants. 16 See Figure D 12 for approval documents.

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203 The experience of veterans in the PBCVTC should also be explored. Such experiences include, but are not limited to, the difficulty with components, experience with team members, perceptions on effective and i neffective components, experience with mentors, whether they feel pressure to participate, and experiences in specific treatment programs17. Results have the potential to yield important policy recommendations. One of the most intriguing findings of m y research was the relatively low use of peer mentors despite the prominence of mentor programs (both nationally and in the case study). Building upon these findings, research should further explore this phenomenon, including its causation and impact18. Add itionally, research should explore the differences and similarities of veteran participants and mentors, and whether, and if so how, these similarities and differences affect such things as progress in the programs, well being, and feelings of support19. A s previously discussed, implementation affects outcomes (Durlak and DuPre, 2008). Following implementation evaluations and utilizing implementation data, the relationships between the implementation and outcomes in VTCs must be conducted. For example, the effect of n ot evaluating certain veterans, tension between District Attorneys Office and VTC team, relationship between VA and VTC, and deviation or 17 My study was designed to capture this information in the veteran interviews. All areas mentioned including many others regarding experience and opinions of the PBCVTC and its process are included in my data. 18 I have begun to do so in several ways. Currently, I am currently working with Dr. Annette Christy from the University of South Florida to further explore the mentor component within VTCs, using an expanded set of mentor items (quantitative and qualitative data) that were located in the national survey. 19 In addition to the participant interviews, I also intervi ewed the mentors in the PBCVTC. I plan to utilize these data to explore the mentor experience in the PBCVTC. Additionally, I plan to examine the differences and similarities of v et eran participants and mentors and and the affect of mentoring on the participants, utilizing both the veteran participant and mentor interview data.

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204 adherence to reward/sanction ladder or phase progression on outcomes overall and for certain participant profiles should be examined. Mechanisms for Diffusion Another area of inquiry focuses on mechanisms of diffusion. Scholars have researched the internal and external mechanisms of policy diffusion. External factors such as social learning at the state level (Berry and Berry, 1990), proximity to adopting states (Berry and Berry, 1990, 1992), large numbers of adoptions (Gray, 1973) and the legitimacy related to those large numbers (Jensen, 2003) have been discovered. Internal factors include how f avorable characteristics within a state are toward innovation (Berry and Berry, 1990), the existence of policy entrepreneurs (Mintron, 1997; Mintrom and Vergari, 1998), the relationship between state officials and professional groups and policy networks favorable toward reform (Walker 1969; Mintrom and Vergari, 1998), and the fiscal characteristics of the state (Berry and Berry, 1990). These internal and external factors have been shown to vary over time (Mooney, 2001; Jensen, 2003). To date, no research h as been published on the mechanisms of specialized court diffusion, but research has been conducted on the adoption of court reforms this research has been deemed complex and wrought with challenges for the researcher. Trial courts appear to be excellent c andidates for reform and innovation due to: 1) a lack of centralized policy allowing for freedom in judicial and court administrator operation and 2) a preexisting network of the judiciary, court administrators, and attorneys for learning and diffusion. H owever, research has shown that many reforms have not spread (Baar and Henderson, 1982; Caldeira, 1982; Feeley, 1983). Reasons for failure have been cited as poor understandings of judicial system policy, the history of the

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205 problem, the complexity of the c ourt system, and current knowledge of organizations (Baar and Henderson, 1982; Feeley, 1983; Saari, 1976), as well as the reliance on the government for resources (Tobbin, 1999). Given societys acceptance of the issues facing veterans, the influx of returning veterans, the delayed onset of issues, and the residence of veterans in every state, I anticipate the continued diffusion of VTCs. The mechanisms of the current and predicted futurediffusion warrant examination both in its own context and in compari son to other court reforms and spread of other specialized courts. Theoretical Framework Finally, scholars should examine the VTCs implied theoretical basis, the life course paradigm. The VTC is p redicated on the idea that military service is connected cha llenges faced after service, which may lead to contact with the criminal justice system. Life course research has examined the role military experience has played in the life course (for example, Clausen, 1995; Elder, 1986, 1987, 1989, 1998; Elder and Shan ahan, 2006; Laub and Sampson, 2003; Rutter, 1996; Sampson and Laub, 1993, 1996). Elder (1986, 1998) found that military service constitutes a life transition or developmental turning point, and t hese transitions or turning points can be negative or positiv e and can change or sustain individuals on certain trajectories20. Research has also focused on the impact of military experience on criminal offending in the life course. 20 For example, being encompassed by the military total institution has been shown to shift individuals onto more positive trajectories, e.g., greater competence, more social equality, and less crime (Clausen, 1995; Elder and Shanahan, 2006; Rutter, 1996; Sampson and Laub, 1996). In contrast, qualitative research of the World War II veterans revealed life disruption due to service and continued offending (Laub and Sampson, 2003; Sampson and Laub, 1993). Regardless of combat experience, one in five Vietnam veterans were found to experience something similar to delayed stress reactions in the year after discharge, and this number continued to grow after that first year (Kadushin, Boulanger, and Martin, 1981).

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206 With regard to the all volunteer force (post Vietnam era), crime increased for vetera ns in comparison to nonveterans, and the likelihood of violent crime commission is higher for veterans than comparable nonveterans (Bouffard, 2005)21. Additionally, c omba t exposure has resulted in both positive and negative effects in the life course War c ombat can initiate or exacerbate stress symptoms (Elder and Clipp, 1989). Combat experience has been shown to increase marriage problems (Gimbel and Booth, 1994; Pavalko and Elder, 1990; Ruger, Wilson, and Waddoups, 2002), e.g., divorce, separation, domest ic violence, and adultery (Gimbel and Booth, 1994; Ruger et al., 2002)22, and likelihood of antisocial actions, e.g. arrest and use of weapons in fights (Gimbel and Booth, 1994). The result of combat exposure may depend on how the veteran perceives his/her experiences. Those who had a positive perception of their war experience had fewer PTSD symptoms than those who did not perceive positive effects, such as learning cooperation and how to cope with challenges (Aldwin et al., 1994; Spiro et al. 1994). PTSD a nd age and timing affect the life course. When looking at PTSD and the life course, it has been found that individuals may remain in low paying and low stress jobs, which hinders opportunities (Brunello et al., 2001; Ettner, Frank, & Kessler, 1997; Jayakody, Danziger, & Kessler, 1998). PTSD has also been found to adversely affect 21It is important to note that selection by both the individual and the military institution is a challenge rendering experimental design impossible and results in the veteran population having different characteristics than the nonveteran population. Criminal offending before enlistment has been found to be a strong predictor of military service (Bouffard 2003, 2005; Johnson and Kaplan, 1991). 22 Vietnam combat v eterans were more likely to have emotional and school problems before service than the Vietnam noncombat veterans. However, even when controlling for these differences before service, Vietnam combat veterans experience marital difficulties more than Vietnam noncombat veterans (Gimbel & Booth, 1994). Also, the affect of service on marriage in the all volunteer force differs by race. In the nonveteran population, African Americans are more likely to divorce than whites; however, in the veteran population, Afr ican Americans are less likely to divorce than whites (Lundquist, 2006).

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207 educational achievement (Kessler et al., 1995), marriage (Kessler, Walers, & Fortholfer, 1998), and having children (Ettner et al., 1997; Jayakody et al., 1998).23 Age and timing of enlistment can also affect trajectories (Elder, 1998; Elder, Shanahan, and Clipp, 1994; Sampson and Laub 1993, 1996). An early enlister, age 17, may be impacted differently and a 23year old recruit due to the respective developmental and social stages. S everal researchers have found that veterans who enlisted in their thirties were more negatively affected than those who enlisted at a younger life stage (Elder, 1986, 1987; Sampson and Laub, 1996; Wright, Carter, and Cullen, 2005). Also, the timing of marriage and war has an impact on divorce rates. Middle class Californians who married during World War II had lower divorce rates by 1955 than individuals who married before the start of the war (Pavalko and Elder, 1990)24. Timing of enlistment (stage in the l ife course) and historical context at time of enlistment has also been shown to affect the relationship between military service and crime (MacLean and Elder, 2007). As previously discussed, World War II service acted as a positive turning point for many; however, service in Vietnam has produced more negative outcomes for many. Vietnam veterans have higher rates of marijuana and 23 Revist the PTSD section under Veterans Issues for a more thorough review. 24 Historical context affect s the impact of military service on the life course. MacLean and Elder (2007) provide the extreme example that serving during war or peacetime can result in entirely different serious outcomes: life or death (p. 177). One can imagine that reintegration for World War II and Vietnam veterans differed greatly given the social and pol itical climates of the respective post war eras. Egendorf et al. (1981) discovered large differences in psychological distress depending upon whether the Vietnam veteran returned to the United States before or after 1968, which they speculated was when man y began to negatively view Vietnam soldiers. However, other scholars have not found these same results (Card, 1983). Mayer (1988) examined the influence of World War II, post war conditions, and reunification on German work life. Ninety seven percent of German males born between 1915 and 1925 had military experience resulting in being removed from the workforce for several years. This group had high rates of imprisonment both during and after the war and had a 25% mortality rate. The cohort born around 1930 experienced disrupted education and home life, and by the time they aged into the work force, Germanys economy was suffering its own post war trauma, which resulted in high rates of unemployment and lack of job advancement. Further, the timing of war af fects whether service is voluntary or involuntary, which can affect the experience of military service.

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208 alcohol use than other veterans and nonveterans (Wright et al., 2005). Vietnam veterans who enlisted at older ages (later life stages) also showed greater usage rates than those who enlisted earlier in life (Wright et al., 2005). The VTC operates on the premise that military service represent s a distinct enough life course experience to warrant a specialized court solely for veterans25. However, VTCs not only implicitly base their goals and operations on this belief that military experience affects veterans throughout the life course but it also attempts to serve as an intervention, to change the veterans offending trajectory by prov iding treatment and supervisions resulting in a turning point. The discussion of VTCs within this framework allows us to examine and discuss the importance and impact of interventi ons using specific terminology ( e.g., whether VTC participation is just a tr ansition or actually a turning point for some research should also determine for whom), providing an easier and clearer collaboration across disciplines The interdisciplinary essence of the framework largely corresponds with the varied challenges veterans face (Chapter 2) and the wide variety of issues VTCs aim to address Conclusion The social impact of war merits systematic treatment by social scientists but has not received it. Many substantial empirical contributions have added to our understanding of aspects of this subject, but these have rarely been well enough integrated in the literature to bring them to bear on one another. Rather, the currency of particular elements of war has led to the sporadic production of ad hoc, rather than theoretically directed, work. We must consider the more sobering aspects of the consequences of war: 25 An alternative explanation for the creation of VTCs is the idea of public service entitlement, i.e., that veterans have earned special treatment due to their service to the nation. However, this concept does not account for the VTC design and missions. On the other hand, it does make the idea of a specialized court for veterans a justified idea for many across the political spectrum, thus, promoting i ts rapid diffusion.

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209 the creation of the veteran role and the infliction of war wounds, physical, psychological, and hidden. (Modell and Haggerty, 1991:219221) This dissertation research has captured VTCs both across the country and in a single unique VTC at a moment very close to their creation. By providing the very first detailed picture of the national VTC landscape, t his dissertation serves as a foundation for fut ure research int o the creation, implementation, and impact of these promising treatment oriented courts. The detailed case study of the PBCVTC serves as both a foundation for further study into that courts efficacy and comparative studies. This project, and the ones that will follow, have real public policy significance. Large populations of veterans both old and young suffer from serious mental he alth and substance abuse issues and find themselves entangled in the criminal justice system. Despite years of research, we ar e still not as aware as we should be of the full extent and nature of the problems these veterans face. Moreover, these veterans are challenged with substantial barriers to treatment and services for reasons yet not fully understood. To add to the policy c hallenge, the veteran population is rapidly growing with the influx of veterans returning from OIF/OEF/OND and population is changing This newest wave of Americas veterans are returning with more mental and physical injuries due to increased survival rates, increased deployments, extended deployments, and the nature of current combat. Adding to the complicated policy challenge, immediate onset of mental health or substance abuse issues is not experienced by many veterans. The Institute of Medicine (2010) predicted the full extent of these war related injuries of the OIF/OEF/OND veterans may not be realized until 2040 or later (Chapter 1).

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210 Our veterans are in need of care. R esearchers and the U.S. government anticipate veterans in need to increase due to t he influx of returning OIF/OEF/OND veterans and delayed onset of issues as well as cuts in VA benefits and the barriers that challenge veterans access to services and treatments. VTCs and their researchers need to be conscious of the fluid and changing nature of veterans and their needs. Faced with these enormous challenges, the rapidly diffusing VTC stands on the front lines of Americas response to troubled veterans in the criminal justice system It is therefore essential that systematic evaluation of V TCs continue immediately in effort to determine, and later employ, evidencebased policy that our nations veterans deserve.

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211 APPENDIX A TABLES Table A 1. BJS Special Report on Veterans in State and Federal Prison, 2004 (Noonan & Mumola, 2007:5) Most Serious Offense Mean Maximum Sentence Length (Months) of State Prisoners in 2004* Veterans Nonveterans Violent 232 204 Homicide 326 308 Rape/Sexual Assault 236 208 Robbery 221 198 Assault 164 138 Property 122 100 Drug 100 88 Pub lic Order 96 74 Excludes life sentences and death sentences.

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212 Table A 2. Percentage of Veterans in State Prison by Service Era BJS Special Report o n Veterans in State and Federal Prison, 2004 (Noonan & Mumola, 2007:6) Characteristics Vietnam era (19641973) n=43,400 Post Cold War (19902004) n=20,200 Age (median years) 53 35 Substance dependent or abusing 58.7% 62.1% Any mental health problem 47.9% 56.7% Current Offense Violent 60.7% 57.4% Property 13.0% 17.0% Drug 12. 6% 11.9% Public Order 13.7% 13.7% Prior Drug Use Ever Used 71.7% 72% Used in the month before the offense 37.1% 44.2% Under the influence at t ime of the offense 21.0% 19.9% Prior Alcohol Abuse Regularly Used 70.4% 66.4% Under influence at time of the offense 32.6% 24.6% Substance dependent or abusing 58.7% 62.1% Any mental health problem 47.9% 56.7%

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213 Table A 3 National Compendium & Survey Timeline Dates Actions June, 2010 Google Alerts created September October, 2011 Survey instrument drafted December, 2011 Survey instrument approved by dissertation committee February, 2012 Feedback on survey requested from VJOs March, 2012 Survey revised Survey submitted for IRB approval April, 2012 IRB exempted survey M ay, 2012 Google Alerts removed Initial compendium list created using internet resources gathered through Google Alerts Included VTCs from Justice for Vets website Contacted administrative court offices June, 2012 VTCs on initial list contacted Su rvey sent out participants (initial list) August 13, 2012 Emailed participants who had not completed the survey yet (initial list) September 15, 2012 First deadline for completion for participants (initial list) Second contact with participants who di d not complete survey (initial list) October 1, 2012 Second deadline for completion for participants (initial list) Third contact with participants who did not complete (initial list) request additional contact October 2, 2012 Called new contacts (re vised list #1) Sent survey to new contacts (revised list #1) October, 2012 Updating VTC list contacted administrative court offices a second time (revised list #2) November 1, 2012 Deadline for completion for new participants (revised list #1) Novem ber 2, 2012 Called participants that did not meet November 1st deadline (added to revised list #2) Called new VTCs (revised list #2) Survey sent to contacts on revised list #2 November 2628, 2012 Reminder calls and emails made to those who did not c omplete yet (revised list #2) December 1, 2012 Survey closed

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214 Table A 4 List of Veterans Treatment Courts in the United States as of November 2012 VTC Name State Status Listed on Justice For Vets Website Anchorage V C AK In Operation Yes Lonoke Coun ty VTC AR In Operation Yes Pulaski/Perry County VTC AR In Operation Yes Maricopa County (Phoenix) VC AZ In Operation Yes City of Tucson (Pima County) VC AZ In Operation Yes Los Angeles VC CA In Operation Yes Orange County Combat VC CA In Operation Yes Riverside County V T C CA In Operation No San Diego VTC CA In Operation Yes San Bernardino VTC CA In Operation Yes Santa Clara County VC CA In Operation Yes Tulare County VC CA In Operation Yes Ventura County Veterans Intervention Program CA In Opera tion Yes Santa Barbara County VTC CA In Operation Yes Fourth Judicial District Veterans Trauma Court (El Paso and Teller Cou nties ) CO In Operation Yes Kent County VTC / Delaware State VTC DE In Operation Yes Jacksonville Veterans Treatment Track FL In Operation No Miami Dade County VTC FL In Operation No Ocala VTC FL Planning Stages No Okaloosa County VTC FL In Operation Yes Osceola and Orange Counties VTC FL Planning Stages No Palm Beach County VTC FL In Operation Yes Augusta VTC GA Planning Stag es Yes Chatam Savannah V T C GA In Operation Yes Muskogee County VC GA In Operation Yes Bannock County VTC ID In Operation No Ada County VC ID In Operation Yes Cook County V T C IL In Operation Yes Madison County V T C IL In Operation Yes Lake County Veterans Treatment and Assistance Court (VTAC) IL In Operation Yes Porter County V T C IN In Operation Yes

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215 Vanderburgh County V T C (Evansville) IN In Operation Yes Grant County VTC IN In Operation No VTC of Southern Indiana ( Floyd County ) IN In Operation Ye s Delaware County VC IN Planning Stages No New Orleans VTC LA In Operation Yes Norfolk County ( Dedham District ) VTC MA In Operation Yes Ionia County VC MI In Operation Yes Matt Brundage Memorial VTC ( Ingham County ) MI In Operation Yes Macomb County VTC MI In Operation No Oakland County VTC MI In Operation Yes Seventeenth Judicial District VC MI In Operation Yes Wayne County VTC MI Planning Stages Yes Hennepin County VTC MN In Operation Yes Washington County VC MN In Operation No 8th Circuit (Le ake, Neshoba, Newton, and Scott County) VTC MS In Operation No Forrest / Perry County VC MS In Operation No Jackson County VTC MO In Operation Yes Kansas City Municipal V TC MO In Operation Yes Dunklin County South East Missouri VTC MO In Operation Yes S t. Louis City VTC MO In Operation Yes Missoula VC MT In Operation Yes Yellowstone County VTC MT In Operation Yes 2nd Judicial District/Bernalillo ( Albuquerque ) VC NM In Operation Yes Clark County Municipal VC NV In Operation No Las Vegas Justice Court VC NV In Operation No Washoe County VC NV In Operation Yes Albany County VTC NY In Operation Yes Albany Regional VTC NY In Operation Yes Amherst VTC NY In Operation Yes Buffalo VTC NY In Operation Yes Brooklyn Treatment Court NY In Operation Yes Chautauqua County VC (Jamestown) NY In Operation No Batavia Treatment Court, Veterans Track NY In Operation Yes Rochester VC NY In Operation Yes

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216 Nassau (Mineola) County VC NY In Operation Yes Queens VC NY In Operation Yes Rennselaer County VTC NY In Operation Yes Rennselaer Regional VTC NY On Hold Yes Suffolk County VC NY In Operation Yes Sullivan County VTC NY In Operation Yes Cleveland Municipal Court Veterans Treatment Docket Court OH In Operation No Hamilton County VTC OH In Operation Yes M ansfield Municipal VC (Richland County) OH In Operation Yes Stark County Honor Court OH In Operation No Youngstown Municipal VTC OH In Operation Yes Creek County VC OK In Operation Yes Tulsa VTC OK In Operation Yes Klamath County VC OR In Operation Ye s Allegheny County VC PA In Operation Yes Berks County VC PA In Operation Yes Bucks County VC PA Planning Stages No Butler County VC PA Planning Stages No Cambria County VC PA Planning Stages No Chester County V C PA In Operation Yes Cumberland Count y VC PA Planning Stages No Dauphin County (Harrisburg) VTC PA In Operation No Delaware County VC PA In Operation Yes Fayette County VC PA Planning Stages No Lackawanna County (Scranton) VC PA In Operation Yes Lancaster County VTC PA In Operation No L ebanon County VC PA Planning Stages No Lehigh County VC PA Planning Stages No Luzerne County VC PA Planning Stages No Montgomery County VC PA In Operation Yes Northumberland County VTC PA In Operation Yes Philadelphia VC PA In Operation Yes Washingto n County VC PA In Operation Yes York County VTC PA In Operation No The Rhode Island VTC RI In Operation No Charleston County VC (9th Circuit VTC) SC In Operation No Bexar County VTC (San Antonio) TX In Operation Yes Dallas County VC TX In Operation Ye s

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217 El Paso County VTC misdemeanors TX In Operation Yes El Pa so County VC Program felonies TX In Operation Yes Guadalupe County VC TX In Operation Yes Nueces County VC TX In Operation Yes Smith County VTC TX Planning Stages No Tarrant County (Fort Worth) Veterans Court Diversion Program TX In Operation Yes Travis County VC TX In Operation Yes Harris County (Houston) VTC TX In Operation Yes Hidalgo County VTC TX Planning Stages Yes Denton County VC TX In Transition Yes Salt Lake City Justice V C UT In Operation No United States District Court of Utah UT Fede ral In Operation No Hampton Ro a ds VC VA Planning Stages No Mission VT Chittenden County VT In Transition No Clark County Veterans Therapeutic Court WA In Operation Yes Seattle VTC WA In Operation No King County Veterans Regional Court WA In Operation Yes Kitsap County VC WA Planning Stages No Pierce County Veterans Drug Treatment Court WA In Operation Yes Spokane County Enhanced Treatment Court WA In Operation Yes Thurston County V TC WA In Operation Yes Northern Panhandle Mental Health and VTC Program WV In Operation No Northeast Wis consin VTC (NEWVTC): B rown, Door, Marinette, Oconto, and Kewaunee Counties WI In Operation No Eau Claire County VTC WI In Operation Yes Dodge County VC WI In Operation No Iron County VC WI In Operation Yes La Crosse Area VC WI In Operation Yes Outagamie County VC WI In Operation No Pierce County VC WI In Operation No

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218 Rock County Regional VC WI In Operation Yes Waupaca County Veterans Assistance Program WI In Operation No Milwaukee Veterans Program WI Planning Stages No

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219 Table A 5 Location of Veterans Treatment Court s by Region and State (N=114 VTCs*) Location: Region and State Number Identified Percentage of VTCs Nationally Location: Region and State Number Identified Percentage of VTCs Nationally Northeast 27 23.68% Midwest 32 28.07% New York 13 11.40% Wisconsin 9 7.89% Pennsylvania 12 10.52% Ohio 5 4.38% Massachusetts 1 0.01% Michigan 5 4.38% Rhode Island 1 0.01% Indiana 4 3.50% Connecticut Missouri 4 3.50% New Jersey Illinois 3 2.63% Vermont Minnesota 2 1.75% New Hampshire North Dakota Maine South Dakota South 25 21.92% Nebraska Texas 9 7.89% Kansas Florida 4 3.50% Iowa Arkansas 2 1.75% West 30 26.31% Georgia 2 1.75% California 9 7.89% Mississippi 2 1.75% Washington 6 5.26% Oklahoma 2 1.75% Nevada 3 2.63% Delaware 1 0.01% Montana 2 1.75% Louisiana 1 0.01% Arizona 2 1.75% West Virginia 1 0.01% Utah 2 1.75% South Carolina 1 0.01% Idaho 2 1.75% North Carolina Alaska 1 0.01% Virginia New Mex ico 1 0.01% Maryland Colorado 1 0.01% Kentucky Oregon 1 0.01% Tennessee Wyoming Alabama Hawaii *In operation only; excludes on hold, in transition, and in planning stages

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220 Table A 6 Frequency Trends of VTCs in Operation within the 32 States with VTCs (n=32 States with VTCs) Number of VTCs in a State Number of States Percentage of States with VTCs One 10 31.2% Two 9 28.1% Three 2 6.2% Four 3 9.3% Five 2 6.2% Six 1 3.1% Seven Eight Nine 3 9.3% Ten Eleven Twelve 1 3.1% Thirteen 1 3.1% Table A 7 Respondent Characteristics (n=79 VTCs) Respondent Characteristics Percentage Male 51.8% Program or Court Coordinator 32.9% VJO 15.1% Administrator, Director, or Superinten dent 15.1% Judge 8.8% Upper Level Support Staff: Court Analyst, Case Manager, Pretrial Services Supervisor, Clerk 8.8% Probation Services 6.3% Attorney: Assistant County, County, Public Defender, Private 5.0% Other Support Staff: Collaborative, Specia lty, or Treatment Court Officer 3.7% Mentor Coordinator 1.2% Missing 2.5%

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221 Table A 8 Status of Veterans in 79 VTCs Status in VTC Number of Veterans Percentage of Veterans Offered VTC Participation (n=4347) Percentage of Total Participants (n=364 9)* Active Case 1869 42.9% 51.2% Graduate 1227 28.2% 33.6% Initial Opt Out 698 16.0% N/A Terminated 432 9.9% 11.8% Drop Out 121 2.7% 3.3% Returner 1 76 1.7% 2.0% 1 This category is not mutually exclusive. Returners can also be included in the Active, Graduate, Terminated, and Drop Out categories. *This participant group is not mutually exclusive of the offered participation group because the participant group had to be offered the opportunity to participate in the VTC.

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222 T able A 9 Reasons for Opt out and Drop out Reasons for Opting or Dropping Out Percentage of VTCs Reporting Reason for Initial Opt Out (n=69 VTCs)* Percentage of VTCs Reporting Reason for Drop Out (n=44 VTCs)** Program Too Rigorous 37.6% 47.7% Did Not W ant Treatment 15.9%*** 25.0% Thought They Could Get a Better Deal in Criminal Court 8.6% 11.3% Did Not Want to Plead Guilty 7.2% Residency: Change of Residency during Pending Case, Did Not Reside in Jurisdiction 4.3% 4.5% Transportation Issues 2.8% 4 .5% Wanted to Go to Trial 2.8% Stigma 1.4% 2.2% Charges Nolle Prossed 1.4% 2.2% Plea Offer 2.2% Eligible for Other Treatment Courts 1.4% Previous Negative Experience with VA Clinic 1.4% Do Not Know Why 27.5% 13.6% Refused to Answer 2.2% T en VTCs did not have any veterans choose not to participate in VTC. **Thirty four VTCs have not had any veterans drop out to date, and one court reported that dropping out was not an option (participants either graduate or are terminated by the VTC). *** One individual decided to legally continue substance use; specifically, the veteran had the desire to continue marijuana use under the Oregon Medical Marijuana Program.

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223 Table A 10 Reasons for Termination (n=64 VTCs)* Reasons for Termination Percenta ge of VTCs that Have Terminated Non Participation in Treatment 60.9% Failure to Appear in Court 46.8% Violation of Probation 42.1% Positive Drug Test 32.8% Re arrest for Different Offense 29.6% Re arrest for Same Offense 26.5% Other General Noncompl iance with Program 4.6% Absconding 3.1% Negative Medication Screening 3.1% Issues to Severe to Be Handled in VTC 3.1% Failure to Pay Restitution 1.5% *Fifteen VTCs have not terminated any veterans to date, reducing the original sample of 79 to 64 appl icable VTCs.

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224 Table A 11 Demographics of Veterans that Have Ever Participated in 79 VTCs (n=3649 VTC Participants) Demographic Average Percentage Standard Deviation Sex Male 91.7% 14.0% Female* 5.6% 6.0% Race/Ethnicity White (non Hispanic) 62.2% 24.9% African American 30.3% 25.3% Hispanic 11.9% 13.7% Asian, Pacific Islander 0.7% 1.4% Age 18 20 years of age 3.4% 5.4% 21 25 years of age 18.6% 17.6% 26 30 years of age 21.0% 15.0% 31 40 years of age 22.0% 15.3% 41 50 years of age 22.6% 15.1% 51 60 years of age 16.4% 14.5% 61+ years of age 11.8% 10.8% Active Duty Active Duty Reserves 7.6% 11.4% Active Duty 2.9% 5.2% Era OEF, OIF, OND 38.5% 24.6% Vietnam 25.3% 22.1% Gulf War 15.1% 16.0% Branch Army 47.6% 22.2% Marines 29.5% 21.1% Navy 15.7% 14.8% National Guard 13.2% 16.2% Air Force 13.0% 10.6% Coast Guard 5.8% 9.6% Trauma Experience 71.1% 24.0% *The majority of VTCs (61 VTCs, 77%) reported having female participants.

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225 Table A 12 Issues Facing Veteran Participants by Sex Issue Average Percentage of Males (n=3357) Average Percentage of Females (n=219) Standard Deviation for Males Standard Deviation for Females Substance Abuse 81. 1% 67.6% 19.6% 38.9% Mental Health 68.4% 58.8% 25.4% 40.0% Family Issues 55.7% 53.6% 32.0% 40.9% Anger Management, Aggressive/Violent Behavior 44.0% 24.6% 26.5% 33.1% Homelessness 34.2% 31.3% 27.0% 33.5% Table A 13 Veteran Criminal Offenses by S ex Type of Offense Average Percentage of Males (n=3357) Average Percentage of Females (n=219) Standard Deviation for Males Standard Deviation for Females Drug 49.5% 43.4% 30.6% 42.9% DUI or DWI 39.0% 48.7% 23.6% 44.6% Theft or Fraud 22.4% 40.4% 20.4% 3 4.5% Domestic Violence 20.7% 9.8% 19.6% 12.0% Violent (not domestic) 17.6% 27.0% 16.4% 38.3% Traffic (not DUI or DWI) 10.9% 3.7% 16.0% 6.6% Weapons 8.6% 0.6% 8.3% 1.1% Prostitution 5.5% 6.5% 18.6% 8.0%

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226 Table A 14 Mission Components (n=49 VTCs) Imp act Goal Percentage of VTCs Reduce Participant Recidivism, Make Participants Law Abiding Citizens 38.7% Promote or Maintain Public Safety 30.6% Have Participants Gain Productive Lives 14.2% Reintegrate Participants Back into Society 12.2% Have Partici pants Gain Employment 8.1% Rebuild Honor in Participants 6.1% Restore Responsibility/Increase Accountability in Participants 6.1% Achieve Appropriate Disposition for/Protect Legal Rights of Participants 6.1% Have Participants Overcome Drug Dependence 6 .1% Have Participants Overcome Mental Illness 6.1% Have Participants Overcome Homelessness 4.0% Reduce Criminal Justice System Costs 4.0% Achieve Successful Outcomes for Participants 2.0% Have Participants Overcome Educational Deficits 2.0% Return Pa rticipants to Pre Service Functioning 2.0% Increase Participants Court Compliance 2.0% Reduce Time Incarcerated for Participants with Substance Abuse and Mental Health Issues 2.0% Have Participants Continue with Mental Health Treatment 2.0% Process G oal Percentage of VTCs Leave No Veteran Behind*, To Identify Veterans in CJ System 14.2%* Provide Assistance/Services to Participants 10.2% Provide Support for Participants 8.1% Create a Non adversarial System/Coordinated Agency Effort 8.1% Identify V eterans Issues 4.0% Address Complex Veterans Issues 4.0% Address Treatment Needs of Participants 4.0% Create a Supervised Environment 4.0% Create a Helpful Environment 4.0% Work with the Specialized Population of Veterans 2.0% No Process Goal Indi cated 22.4%

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227 Table A 15 VTC Objectives (n=49 VTCs) Objectives Percentage of VTCs Agency Collaboration 34.6% Provide with Treatment Services/Program (vague) 28.5% Use a Problem Solving Approach (also Court Process to Address Recovery/Rehabilitat ion, Link to Treatment as Alternative to Incarceration/Traditional CJ System) 24.4% Provide Substance Abuse Treatment (specific) 10.2% Provide Mental Health Treatment (specific) 10.2% Supervision (excluding judicial) 6.1% Mentoring 6.1% Assess the Vet eran 6.1% Provide Residential Aid (specific) 6.1% Provide a Support System 6.1% Judicial Oversight/Supervision 4.0% Provide Academic Skills (specific) 4.0% Provide Vocational Skills (specific) 4.0% Provide Compassion 4.0% Consider Treatment Needs 4. 0% Consider Seriousness of Offense 4.0% Introduce to Ongoing Process of Recovery/Provide Knowledge about Recovery (general) 4.0% Regular Court Appearances 2.0% Successfully Complete Probation 2.0% Provide Social Services (specific) 2.0% Provide Trans ition Services (specific) 2.0% Provide Job Placement (specific) 2.0% Provide Job Retention (specific) 2.0% Defer Prosecutions 2.0% Treat with Respect, Dignity, Recognition of Service 2.0% Provide Legal Assistance 2.0% Use a System of Sanctions and Re wards 2.0% Mandate Court Requirements 2.0% No Objective Listed 8.1%

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228 Table A 16 VTC Target Populations (n=49 VTCs) Target Population Percentage of VTCs Veterans 51.0% Veterans in the CJ System 24.4% Veterans in the CJ System with Mental Heal th Issues 4.0% Veterans in the CJ System with Substance Abuse Issues 4.0% Veterans in the CJ Syst em with Substance Abuse Issues Resultant from Combat 4.0% Active duty Personnel in CJ System 2.0% Veterans Charged with Non Violent Offenses (felony or mi sdemeanor) 2.0% Veterans with Misdemeanors 2.0% Veterans with Felony Charges that can Be Reduced to Misdemeanors 2.0% Veterans in the CJ System with Behavioral Issues 2.0% Veterans in the CJ System with Mental Health Issues Resultant from Service 2.0 % Veterans in the CJ System with Mental Health Issues Resultant from Combat 2.0% Veterans in the CJ Syst em with Substance Abuse Issues Resultant from Service 2.0% Veterans in CJ System Eligible for VA Benefits 2.0% Active duty Personnel in CJ System El igible for VA Benefits 2.0% Veterans in CJ System Whose Criminal Behavior Is Resultant from Service 2.0% Active duty Personnel in CJ System Whose Criminal Behavior Is Resultant from Service 2.0% Honorably Discharged Veterans with Mental Health Issue Res ulting from Service 2.0% Honorably Discharged Veterans with Substance Abuse Issues Resulting from Service 2.0% Honorably Discharged Veterans with Nonviolent Felony and Service connected Condition 2.0% Honorably Discharged Veterans with Misdemeanors and Service Connected Mental Health Condition 2.0%

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229 Table A 17 General VTC Characteristics Funding Sources Percentage of VTCs (n=79 VTCs) Within System Only 53.1% System, Grants 16.4% System, Additional Government Funds 8.8% System, Donations 7.5% System, Grants, Additional Government Funds 6.3% System, Government Funds, Donations 5.0% System, Grants, Donations 2.5% Number of Judges Percentage of VTCs (n=79 VTCs) One 74.7% Two 19.0% Three 3.8% Four 2.5% Judge Demographics Percentage of Judg es (n=105) Male 76.1% Preside over Other Specialty Court 62.8% Civilian 55.2% Jurisdiction Percentage of VTCs (n=79 VTCs) County 60.7% State 20.2% Municipal (City, Town) 12.6% Federal 1.2% Multiple: County and Municipal 2.5% Multiple: State and M unicipal 1.2% Mul t iple: Federal, State, County, Municipal 1.2% Have a Reward/Sanction Ladder Percentage of VTCs (n=78 VTCs) Yes 74.3% Have Peer Mentors Percentage of VTCs (n=76 VTCs) Yes 80.2% Type of Mentor Percentage VTCs with Mentors (n=61) Commu nity Volunteers (including VFW, DAV) 95.0% VA Employed 4.9% Veteran Participants in Final Phase 1.6% From Non Profit Organization 1.6% Paid by Grant 1.6% Compeer Program 1.6%

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230 Table A 18 Treatments and Services Available by Provider Type (n=79 VTCs) Treatments/ Services Available VA Provider Community Provider Mental Health 97.4% 65.8% Substance Abuse Outpatient 93.6% 69.6% Substance Abuse Inpatient 89.9% 50.6% Substance Abuse Detox 83.5% 50.6% Housing 81.0% 56.9% Vocational Services 79.7% 68.3% Transportation Assistance 60.7% 62.0% Medical Treatment 1.2% Home Goods and Supplies 1.2% Claims Assistance/Advocacy 1.2% Educational Assistance 1.2% 2.5% Table A 19 Stage of Veteran Identification (n=79 VTCs) Participant Identification Percentage of VTCs Arrest 45.5% Booking 69.6% Pretrial Services Interview 62.0% Arraignment 70.8% During Screening for Public Defender 1.2% After Arraignment during Case Processing 49.3% During Probation Caseload Screening/Probation Intake 6.3% Du ring Treatment Court Screening 6.3% Probation Violation/Revocation 5.0% Sometime during Incarceration 2.5% VA Referrals after Arrest 2.5% Sentencing 2.5%

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231 Table A 20 Eligibility Exclusions Military and VA Status Exclusions Percentage of VTCs ( n=59 VTCs) Dishonorable Discharge 47.4% VA Ineligibility 32.2% Bad Conduct Discharge 28.8% Active Duty 11.8% Other Than Honorable Discharge 5.0% None 5.0% General Discharge 1.6% Criminal Status Exclusions Percentage of VTCs (n=74 VTCs) Any Repeat Offenders 2.7% History of Sex Offense Requiring Registration 1.3% Charge Exclusions Percentage of VTCs (n=74 VTCs) Sex Offenses Any Sex Offense Charge 28.3% Child Abuse/Sexual Assault Charges 12.1% Rape 8.1% Registerable Sex Offense 2.7 % Nonviolent Felony Sex Offenses 2.7% Violent Felonies All Violent Felony Charges 45.9% Homicide 17.5% Severe Felony Charges (3G), Aggravated Felonies 8.1% Any Domestic Violence 6.7% Violent Felony with a Weapon 4.0% All Violen t Felonies but Allow Some Domestic Violence 2.7% Violent Felonies unless DA Allows 2.7% Burglary 2.7% Any Pending Felony Charges in Other County 1.3% Nonviolent Felonies DUI 6.7% All Nonviolent Felony 4.0% Crimes Against Children 4.0% Burglary 2.7% ID Theft 1.3% Arson 1.3% Weapons 1.3% Drug Offenses Any Drug Trafficking 6.7% Any Drug Sales 6.7%

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232 All Drug Offenses 1.3% Felony Drug Possession Level 2 1.3% High Level Drug Trafficking 1.3% Traffic O ffenses All Traffic Offenses 18.9% Traffic Citations/Violations 5.4% Misdemeanor Traffic 2.7% Reckless Driving 1.3% Miscellaneous/Level Not Specified Any Misdemeanors 4.0% Assault 2.7% Enhanced Firearms Charges 2.7% Kidnap ping 1.3% Multiple Weapons Charges 1.3% Sentence Exclusions Percentage of VTCs (n=74 VTCs) Mandatory Sentences, Three Strikes 6.7% Sentences without Supervision Mandate 1.3% Sentences with More than 3 Years of Supervision 1.3% Offenses Requiring L ife Sentence 1.3% Other Exclusions Percentage of VTCs (n=74 VTCs) No Identified Need of Treatment Services 2.7% Serious Bodily Injury to Victim 1.3% Previous Acceptance to VTC Program 1.3% Deemed Nontreatable 1.3%

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233 Table A 21 Elig ibility Screeners (n=77 VTCs) Eligibility Screener Percentage of VTCs VJO 54.5% VTC Coordinator 50.6% Prosecuting Attorney 45.4% Public Defender 38.9% Private Attorney 24.6% Corrections Personnel 20.7% Law Enforcement Officer 15.5% Probation/Parol e Officer 12.9% Peer Mentor 9.0% VTC Judge 5.1% VTC Team as a Whole 5.1% Clinical Evaluator (Substance Abuse, Mental Health) 3.8% Alternative Treatment Court Coordinator (Mental Health Court or Drug Court) 3.8% Pretrial Services 2.5% VSO 2.5% Men tor Coordinator 1.2% Probation/Parole Supervisor 1.2% VA Personnel 1.2% County Veterans Assistance Commission 1.2% First Appearance Judge 1.2% Court Interns 1.2%

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234 Table A 22 Initial Evaluation Information (n=79 VTCs) Initial Evalu ator Percentage of VTCs Areas of Evaluation Percentage of VTCs VJO 75.9% Mental Health 100.0% Community Treatment Provider 35.4% Substance Abuse 100.0% VA Treatment Provider 30.3% Trauma Exposure 96.2% Other VA Personnel 12.6% Physical Health 93.6% Pr obation Officer 8.8% Family Relationships 89.8% VTC Coordinator 6.3% Social Support 89.8% VTC Case Manager 3.7% Housing 88.6% VTC Caseworker, Social Worker 3.7% Employment 87.3% Court Appointed/Assigned Psychologist 3.7% Education 84.8% Prosecuting At torney 2.5% Military or VA Status 5.0% Correctional Facility 2.5% Criminal History 3.7% Judge 1.2% Benefits 3.7% Pretrial Services 1.2% Income, Financial Support 3.7% Public Defender 1.2% Risk Assessment, Public Safety 2.5% Resource Coordinator 1.2% M otivation Level, Treatment Readiness 2.5% VTC Program Manager 1.2% Transportation 1.2% Lead Peer Mentor (with PTSD and TBI instruments) 1.2% Previous Compliance (Treatment, Court, Military Service) 1.2% Drug Court Treatment Liaison 1.2% Goals 1.2% Drug Court Affiliated Doctor 1.2% Gambling Addiction 1.2% Jail Diversion Trauma and Reentry Program 1.2% Medication 1.2% Treatment to Alternative Street Crime (TASC) Case Management Agency 1.2% Previous Treatment Participation 1.2% VSO 1.2%

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235 Table A 23 Participation Requirements (n=79 VTCs) Participation Requirements Percentage of VTCs Treatment 100.0% Frequent Court Appearances 92.4% Sign a Contract 81.0% Check in Regularly outside of Treatment or Court Appearances 75.9% Plead Guilty 60.7% Proba tion 55.6% Meet with Mentor 11.3% Random Drug Testing, Drug/Alcohol Monitoring 8.8% Sign Release of Information (Treatment Participation and Progress) 3.7% Random Searches/Home Visits 2.5% Curfew 2.5% Obtain Employment, Enroll in School, or Volunteer 2.5% Not Possess Weapons 2.5% Pretrial Services Monitoring 1.2% Medication Screening 1.2% Reside within VTC Jurisdiction 1.2% Agree to Diversionary Plea Agreement (Adjudication Withheld until Completion) 1.2% Table A 24 Means of Supervision (n=75 VTCs) Means of Supervision Percentage of VTCs Drug Testing 100.0% Reporting to Agency 97.3% Treatment Attendance Verification 94.6% Housing Checks 76.0% Medication Level Testing 65.3% Employment Checks 58.6% Curfew Checks 46.6% Electronic Monitor ing 45.3% GPS Monitoring 25.3% SCRAM 6.6% Mentor 2.6% Ignition Interlock 1.3%

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236 Table A 25 Mentor Assignment (n=61) Individual Involved in Assigning Mentors Percentage of VTCs with Mentors Mentor Coordinator 47.5% VTC Coordinator 18.0% Judge 8.1% VTC Team 4.9% Mentors and Participants Select Each Other 3.2% VJO 3.2% Probation Officer 3.2% Chief/Supervisor Mentor 3.2% Mentors 1.6% Prosecuting Attorney 1.6% Court Staff 1.6% VSO 1.6% Treatment Provider 1.6% Mentor Leadership Team 1.6% Compe er Director 1.6% Case Manager 1.6% Table A 26 Frequency of VTC Sessions and Meetings (n=79 VTCs) Frequency of VTC Sessions (mutually exclusive) Percentage of VTCs Two to Three Times a Week 3.7% Once a Week 46.8% Two to Three Times a Month 35.4% Once a Month 10.1% Less than Once a Month 2.5% As Needed Basis 1.2% Frequency of VTC Team Meetings (mutually exclusive) Percentage of VTCs Two to Three Times a Week 7.5% Once a Week 40.5% Two to Three Times a Month 21.5% Once a Month 7.5% Less th an Once a Month 6.3% Do Not Meet in Person but Communicate outside of Court 12.6% As Needed 1.2% Never outside of Court 2.5%

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237 Table A 27 Frequency of VTC Member Presence during VTC Sessions (n=74 VTCs) Individuals Present Always Often Sometimes Rarel y Never Missing Judge 100.0% Veteran Participant/Offender 86.4% 5.4% 1.3% 2.7% 4.0% Prosecuting Attorney 79.7% 5.4% 6.7% 5.4% 1.3% 1.3% VJO 78.3% 6.7% 5.4% 4.0% 2.7% 2.7% Public Defender 74.3% 6.7% 8.1% 6.7% 4.0% Probation/DOC Officer 6 4.8% 6.7% 9.4% 2.7% 10.8% 5.4% Court Reporter 60.8% 4.0% 4.0% 8.1% 18.9% 4.0% Peer Mentors 55.4% 5.4% 16.2% 4.0% 1.3% 17.5% Treatment Provider 31.0% 14.8% 25.6% 14.8% 12.1% 1.3% Private Attorney 24.3% 10.8% 37.8% 18.9% 5.4% 2.7% Other VA Personnel 25 .6% 5.4% 10.8% 25.6% 32.4% VTC/Program Coordinator 22.9% 77.0% Family Members 6.7% 28.3% 45.9% 12.1% 2.7% 4.0% Case Manager/Case Worker 5.4% 94.5% VSO 2.7% 97.2% County Veterans Benefit Specialist 1.3% 98.6% Clerk of Court 1.3% 98.6% Mentor Coordinator 1.3% 98.6% Pretrial Services Officer 1.3% 98.6% VTC Assistant 1.3% 98.6%

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238 Table A 28 Legal and Financial Benefits of Participation/Graduation (n=79 VTCs) Benefit Percentage of VTC s Diversion from Incarceration 92.4% Charges Dropped 70.8% Charges Reduced 65.8% Adjudication Withheld 36.7% Early Probation Termination 7.5% Expunction 5.0% Reduction in Court Fines/Fees 3.7% Sentence Modification 2.5% Reduction in Probation Cost s 2.5% Probation/Parole Revocation Diversion 2.5% Seal Record 1.2% Civil Legal Aid 1.2% Reduced Supervision 1.2% Benefit and Claim Assistance 1.2% Opportunity for Favorable Discharge or Retention (for Active Duty) 1.2% Emergency Financial Assistance 1.2% Unsupervised Probation 1.2%

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239 Table A 29 Graduation Requirements (n=79 VTCs) Requirement to Graduate Percentage of VTCs Complete Treatment Requirements 98.7% Complete Court Mandates 79.7% Complete Probation (If Put on Proba tion) 65.8% Achieve Stable Housing 46.8% VTC Team Unanimously Agrees Veteran Has Completed Requirements 46.8% Treatment Evaluation Must State Veteran Has Improved 37.9% Majority of VTC Team Agrees Veteran Has Completed Requirements 36.7% 6 Months of S obriety 10.1% Complete All Phases of Program 6.3% 6 Months of Employment, School, or Community Service (Full Day Schedule) 3.7% No New Arrest while Participating 3.7% Financially Stable 2.5% Complete 1 Year of the Program 2.5% Drug Court Judge Belie ves Veteran Has Completed the Program after 5 Years 1.2% Complete Aftercare Plan 1.2% Write Paper 1.2% Table A 30 Mentoring Issues (n=31 VTCs) Issue Percentage of VTCs Retention 12.9% Recruitment 12.9% Too time consuming for mentors with full ti me jobs 9.6% Overstepping boundaries (counseling, law enforcement), Role identification 9.6% Screening 9.6% Too new, still trying to identify the mentor role 9.6% Supervision, keeping in contact 9.6% Incidental costs 6.4% Too many personal issues 6. 4% Need younger mentors 6.4% Training 6.4% Collaboration issues with agency that manages mentors 3.2%

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240 Table A 31 Perceptions of Participant Change (n=62 VTCs ) Change Percentage of VTCs Decrease in/Cessation of Substance Abuse 32.3% Increase in Sens e of Pride/Self Esteem/Integrity 24.1% Outlook More Positive/Gain Hope/More Positive about Future 20.9% Improvement in Relationship with Family 17.7% Gain Steady Employment 16.1% Reintegrate with the Community 16.1% Decrease in Mental Health Issues/S ymptoms, Less Stress/Anxiety 14.5% Increase in Responsibility/Accountability 12.9% Increase in the Understanding of Themselves/Cause of Behavior 11.2% Improvement in Communication and Social Skills 9.6% Stabilization of Housing Situation 9.6% Increas e in Compliance with the Law 9.6% Increase in Treatment Compliance 9.6% Increase in Trust of VTC Team 8.0% Make Friends, Improvement in Relationships with Friends 8.0% Become Goal Oriented/Get a Sense of Purpose 6.4% Enroll in School 6.4% Begin to Be lieve in Recovery 6.4% Increase in Willingness to Reach out/Ask for Help/Be More Open 6.4% Become Supportive of Other Participants 4.8% Become More Aware of Services and Benefits Available 4.8% Become More Grateful 4.8% Improvement in Physical Health 3.2% Increase in Treatment Responsivity 3.2% Gain Coping Mechanisms 3.2% Increase in Financial Stability 3.2% Increase in Social Support (general) 3.2% Increase in Independence 1.6% Admonish Other Participants when Noncompliant 1.6% Become Less A ffected by Peer Behavior 1.6% Become More Organized 1.6% Become More Outgoing 1.6% Increase in Cognition 1.6% Increase in Focus 1.6% Increase in Medication Compliance 1.6% Become More Humble 1.6% Become More Disciplined 1.6% None 1.6%

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241 Table A 32 Most Effective Components of VTC (n=79 VTCs) Effective Component Percentage of VTCs Counseling/Treatment 30.3% Mentoring 24.0% Knowing the VTC Team Wants Them to Succeed/Takes the Time for Them to Succeed 21.5% Camaraderie and Understanding of Fellow Veterans/Peer Support 18.9% Holding Them Accountable/Application of Sanctions 17.7% Relationship with Judge 17.7% Non adversarial Court Team Approach 13.9% General Incentives, Recognition for Achievement, Positive Reinforcement 8.8% Structure 8.8% C onstant and Comprehensive Supervision 7.5% Showing Gratitude for Service 6.3% Treating Them with Respect 6.3% Frequent Court Appearances 6.3% Making Them Feel a Part of the VTC Team 6.3% Judge Being Responsive 5.0% Incentive of Charge/Sentence Dismi ssal or Reduction 3.7% Case Management 3.7% Constant Communication between Court and Providers 3.7% Court ordered Treatment 3.7% Judge Being a Veteran or Combat Vete r an 3.7% Judge Being Accessible 2.5% Clear Requirements/Expectations 2.5% Use of Evi dence Based Treatment 2.5% Long term Monitoring 1.2% Military like Discipline 1.2% Tapping into Military Pride 1.2% Written Contract 1.2% Opportunity to Avoid Incarceration 1.2% Unbiased, Uniform Policies 1.2% Rapid Sanction or Treatment Response to Violations 1.2% Identification of Issues 1.2% Compassion 1.2% VTC Team Members Are Veterans 1.2%

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242 Table A 33 Ineffective VTC Components (n=55) Ineffective Component Percentage of VTCs VA Treatment/Counseling Services 18 .0 % Civilian Personnel on VTC Team 3.6% Unclear Expectations, No Policy/Procedures in Place 3.6% Rewards and Sanctions Are not Timely 3.6% Communication between Court and VA 3.6% Location of nearest VA Facility 3.6% Specific Program Tracks 1.8% Use of Supervised Law Students in Place of Attorneys 1.8% Focus on Punishment instead of Treatment 1.8% Shaming 1.8% Not Believing in Rehabilitation 1.8% Treating Veterans as Victims 1.8% Positive Reinforcement 1.8% Harsh Penalties for Victimless Crimes 1.8% Returning Veteran to Same Environment that He/She Was in Prior to Treatment 1.8%

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24 3 Table A 34 Challenges Facing VTCs (n=79 VTCs) Challenges Percentage of VTCs Funding 25.3% Long Wait Lists to Access to VA Services 17.7% Understaffed 15.1% Not Enough Mentors 6.3% Limited Resources (General) 6.3% Lack of Housing Services 5.0% VA Does not Communicate with Court 5.0% Transportation Issues/Location of nearest VA Facility 5.0% Inconsistency with Sanction Application 5.0% Finding Long Term Empl oyment for Veterans 3.7% Access to VA Services Not Available 3.7% VA Does not Have the Resources 3.7% Getting Eligible Participants 3.7% Few Incentives 2.5% Unsupportive Prosecuting Attorneys Office 2.5% VA Cooperation 2.5% Personal Agendas/Politic s Detracts from Focus 1.2% Defense Attorney not Always Present at Meetings 1.2% Unsupportive Community 1.2% VA Services Suspended when Veteran is Incarcerated 1.2% Keeping VTC Team Enthusiastic 1.2% Lack of Training for VTC Team 1.2% Frequent VTC Tea m Member Turnover 1.2% Lack of State Oversight 1.2% VAs Lack of Evening Hours 1.2%

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244 Table A 35 Suggested Changes (n= 58 VTCs) Suggested Changes Percentage of VTCs More Funding (General) 13.7% Improve Relationship with VA (Communicati on, Cooperation) 10.3% Increase VTC Staff 8.6% Better Sentencing Options/Not Mandatory Guilty Plea to Enter 6.8% Increase Housing Services/Options 6.8% More Resources (General) 6.8% Implement a Mentoring Program 6.8% Have (More) Representatives from VBA Attending VTC Sessions 5.1% Mandatory Training for VTC Members and Agencies Working with VTC 5.1% Further Definition and Structure the Program Phases 5.1% Increase Types of Services and Treatments Available 5.1% Allow More Felony Charges to Be Elig ible for Participation 3.4% Start to Utilize Treatment Providers outside of the VA 3.4% Have VA Liaison Attend VTC Sessions 3.4% More Counselors Reporting to Coordinator 1.7% Incorporate VJO from the Beginning 1.7% Establish a VA Funded per Diem Outpa tient Treatment Facility in the Community 1.7% Increase Number of Participants 1.7% Increase Law Enforcement Awareness to Veteran Sensitive Initial Call Responses 1.7% Increase DA Offices Involvement 1.7% Decrease Time from Arrest to Screening 1.7% D ecrease Prosecuting Attorneys Prosecutorial Attitude/Become More Non adversarial 1.7% Have a Mental Health Professional Instead of Prosecuting Attorney Determine Eligibility 1.7% Include County Staff in VTC Responsibilities (screen, assess, place, etc .) 1.7% Increase Residential Treatment Options 1.7% Hire a VTC Coordinator 1.7% Hire a Mentor Coordinator 1.7% Establish a Volunteer Program for Participants Not Yet Ready to Join the Workforce 1.7% Increase the VTC Session to Twice a Week 1.7% Incre ase Supervision 1.7% Defense Attorney/Public Defender to Attend Each VTC session and meeting 1.7% Make Sure Sanctions Are Consistent 1.7% Veteran Preference in the VTC Staff 1.7%

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245 Table A 36 Structure and Staff Model (Model 1a) Variable Cluster 1 (n=2 3 ) Cluster 2 (n=12) Cluster 3 (n=16) Cluster 4 (n=28) Combined (n=79) Mean Total number of services available 5.87 5.67 5.88 5.61 5.75 Total number of supervision means 5.35 6.42 6.56 5.50 5.81 Total number of supervising agents per policy 5.35 6.42 6.56 5.50 5.81 Total number of s upervising agents in practice 3.04 4.25 2.31 3.00 3.06 Frequency (Percentage of Combined ) Frequency External funding sources 10 (28.6%) 9 (25.7%) 16 (45.7%) 0 35 No external funding sources 13 (29.5%) 3 (6.8%) 0 28 (68.3%) 44 One judge 23 (39.0%) 0 16 (27.1%) 20 (33.9%) 59 More than one judge 0 12 (60.0%) 0 8 (40.0%) 20 City /municipal highest jurisdiction 8* (80.0%) 2 (20.0%) 0 0 10 County highest jurisdiction 0* 6 (12.95) 16 (32.0%) 28 (56.0%) 50 State highest jurisdiction 14* (82.4%) 3 (17.6%) 0 0 17 Federal highest jurisdiction 1* (50.0%) 1 (50.0%) 0 0 2 *Surpassed critical line

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246 Table A 37 Structure and Staff Model (Model 1b) Variable Cluster 1 (n=23) Cluster 2 (n=20) Clu ster 3 (n=16) Cluster 4 (n=20) Combined (n=79) Frequency (Percentage of Combined ) Frequency External funding sources 10 (28.6%) 9 (25.7%) 16 (45.7%) 0 35 No external funding sources 13 (29.5%) 11 (25.0%) 0 20 (45.5%) 44 One judge 23 (39.0% ) 0 16 (27.1%) 20 (33.9%) 59 More than one judge 0 20 (100%) 0 0 20 City /municipal highest jurisdiction 8* (80.0%) 2 (20.0%) 0 0 10 County highest jurisdiction 0* 14 (28.0%) 16 (32.0%) 20 (40.0%) 50 State highest jurisdiction 14* (8 2.4%) 3 (17.6%) 0 0* 17 Federal highest jurisdiction 1* (50.0%) 1 (50.0%) 0 0 2 *Surpassed critical line

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247 Table A 38 Treatment Provider Orientation Model (Model 2) Variable Cluster 1 (n=30) Cluster 2 (n=11) Cluster 3 (n=38) Combined (n=79) Mea n Management supervision means 0.70** 0.42** 0.46** 0.55 Treatment supervision means 0.59** 0.36** 0.47 0.50 Management supervising agents per policy 0.56 0.36 0.37 0.44 Treatment supervising agents per policy 0.33 0.27 0.35 0.33 Frequency Number of therapeutic evaluations offered 8.00** 4.18** 7.87** 7.41 Number of t herapeutic participation requirements 2.07 1.82 1.76 1.89 Number of m anagement participation requirements 2.03** 1.36** 0.45** 1.18 p < .05 level ** p < .01 level Table A 39 Eligibility Model (Model 3) Variable Cluster 1 (n=48 ) Cluster 2 (n=26 ) Combined (n=74) Frequency Do not exclude all violent felonies 0* 26* 26 Exclude all violent felonies 48* 0* 48 Mean Total number of v eteran/military exclusions 1.02 0.65 0.89 Surpassed critical line

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248 Table A 40 Full Model (Model 4 a ) Variable Cluster 1 (n=20 ) Cluster 2 (n=18 ) Cluster 3 (n=13 ) Cluster 4 (n=23 ) Combined (n=74 ) Frequency (Percentage of Combined) External funding sources 7 (21.2%) 8 (24.2%) 7 (21.2%) 11 ( 33.3%) 33 No external funding sources 13 (31.7%) 10 (24.4%) 6 (14.6%) 12 (29.3%) 41 Excludes all violent felonies 0* 13 (27.1%) 12 (25.0%) 23* (47.9%) 48 Does not exclude all violent felonies 20* (76.9%) 5 (19.2%) 1 (3.8%) 0* 26 One judge 13 (24.1% ) 18* (33.3%) 0* 23* (42.6%) 54 More than one judge 7 (35.0%) 0* 13* (65.0%) 0* 20 City/municipality maximum jurisdiction 0 7* (77.8%) 2 (22.2%) 0* 9 County maximum jurisdiction 18 (36.0%) 0* 9 (18.0%) 23* (46.0%) 50 State maximum jur isdiction 2 (14.3%) 11* (78.6%) 1 (7.1%) 0* 14 Federal maximum jurisdiction 0 0* 1 (100.0%) 0* 1 Mean Management supervision means 0.61 0.47 0.55 0.58 0.56 Treatment supervision means 0.48 0.52 0.51 0.54 0.51 Therapeutic evaluations offere d 7.95* 7.94* 6.54 7.43 7.54 Management participation requirements 1.30 1.06 1.38 1.09 1.19 Surpassed critical line

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249 Table A 41 Full Model without Maximum Jurisdiction (Model 4b) Variable Cluster 1 (n=34 ) Cluster 2 (n=20 ) Cluster 3 (n=20 ) Combined (n=74 ) Frequency (Percentage of Combined) External funding sources 5 (15.2%) 9 (27.3%) 19 (57.6%) 33 No external funding sources 29 (70.7%) 11 (26.8%) 1 (2.4%) 41 Excludes all violent felonies 16 (33.3%) 12 (25.0%) 20 ( 41.7% ) 48 Does not exclude all violent felonies 18 (69.2%) 8 (30.8%) 0 26 One judge 34 (63%) 0 20 ( 37% ) 54 More than one judge 0 20 (100%) 0 20 Management supervision means .57 .53 .57 .56 Treatment supervision means .49 .48 .58 .51 Therapeutic evaluations of fered 7.91 7.05 7.4 0 7.54 Management participation requirements 1.24 1.15 1.15 1.19 Surpassed critical line

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250 Table A 42 List of Veterans Treatment Courts by Region and State (N=114 VTCs) (in operation only; excludes on hold, in transition, and in planning stages) Region and State Number Identified Number that Responded Survey Response Rate Northeast 27 15 55.6% Rhode Island 1 1 100.0% Pennsylvania 12 7 58.3% New York 13 7 53.8% Massachusetts 1 South 25 15 60.0% Mississippi 2 2 100.0% Delaware 1 1 100.0% Georgia 2 2 100.0% Florida 4 3 75.0% Arkansas 2 1 50.0% Texas 9 6 66.7% Louisiana 1 Oklahoma 2 West Virginia 1 South Carolina 1 Midwest 32 25 78.1% Illinois 3 3 100.0% Indiana 4 4 100.0% Minnesota 2 2 100.0% Ohio 5 4 80.0% Wisconsin 9 7 77.8% Michigan 5 3 60.0% Missouri 4 2 50.0% West 30 24 80.0% Montana 2 2 100.0% Arizona 2 2 100.0% Utah 2 2 100.0% Colorado 1 1 100.0% Oregon 1 1 100.0% Idaho 2 2 100.0% Alaska 1 1 100.0% California 9 8 88.9% Nevada 3 2 66.7% Washington 6 3 50.0% New Mexico 1 Total 114 79 69.3%

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251 Table A 43 Non response Rates by Region (N=114 VTCs) Participated in Survey Region Total Northeast South Midwest West Yes 15 15 25 24 79 No 12 10 7 6 35 Total 27 25 32 30 114 Table A 44 Non response Rates by Two Region s (N=114 VTCs) Participated in Survey Region Total East West Yes 30 49 79 No 22 13 35 Total 52 62 114 Table A 45 Case Study Timeline Dates Actions July 2011 August, 2011 Contact PBCVTC officials Approval granted by PBCVTC officials September 2011December 2011 VTC team member interviews Sit in on VTC team meetings Sit in on VTC sessions (open court) Draft VTC team meeting observation instrument Draft VTC session (open court) observation instrument Draft program evaluation tool January 2012 March 201 2 Revise observation instruments Revise program evaluation tool April 2012 IRB Appro val for VTC team meeting observation IRB Approval for VTC session (open court) observation May 2012 August 2012 Observed VTC sessions (open court) weekly Observed VTC team meetings weekly June 2012 September 2012 IRB Approval for Participant Initia l Interviews Initial interviews conducted (Wave I) September 2012 IRB Approval for Participant Follow up (3 and 6 month) Interviews November 2012 February 2013 6 month Participant Follow up Interviews conducted (Wave II)

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252 Table A 46 PBCVTC Team Me mbers Definitions of Success VJO & Community Treatment Coordinator Clinical compliance: attended all treatment appointments Probation Remains in compliance under terms of probation Public Defender & ADA Completed all court obligations (e.g. restitutio n, community service, probation) and clinical compliance Mentor Readjustment, acknowledgement of issues The Court (Judge) Has achieved clinical and probation compliance and has completed all court obligations, has had a change in attitude

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253 Table A 47 Process and Impact Goals Goals Performance Measures Process Goal 1: Early identification and placement in VTC Process Centered Veteran status at booking Veteran status at first appearance Meets with VJO at first appearance Time to case placed on the VTC docket Process Goal 2: Make veterans aware of and put them in touch with services Process Centered First contact evaluation with VJO (general eligibility, housing, mental health, substance abuse, medical) Should be imme diate and upfront Later integration of other services such as educational and vocational assessments, training, and job placement Assigned to treatment providers Process Goal 3: Ongoing judicial interaction with the veteran Process Centered Frequent cour t appearances for status checks Celebrate/acknowledge accomplishments (e.g., gaining employment, enrolling/finishing school) Impact Goal 1: Fulfill court obligations including probation, abstinence from substance use, maintaining medication levels, and obtaining housing Outcome Centered Complete community service hours Pay restitution Obtain drivers license/restore driving privileges Pass drug screening Adhere to curfew and living arrangements Remain in housing (housing checks) Receive drivers license or ID card with address Impact Goal 2 : Prevent future contact with the criminal justice system Process Centered Intervention through VTC o substance abuse treatment o mental health treatment o housing o court appearances before judge o sanction and reward system Outco me Centered Not getting re arrested Impact Goal 3 : Achieve the best case disposition Process Centered Deferred sentence Charges dropped Downfile felony to misdemeanor Impact Goal 4 : Reduce costs associated with criminal case prosecution and re Process/Outcome Centered Treatment provided through VA in lieu of incarceration provided through the state

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254 arrest Charges downgraded Process & Impact Goal 1: Address the mental health and substance abuse issues through long term and comprehensive treatmen t Process Centered Attendance at treatment (e.g., mental health, substance abuse) appointments Evaluations (mental health, substance abuse) Drug screenings Follow ups conducted Outcome Centered Evaluations indicate that mental health and/or substance use b ehavior is improving Process & Impact Goal 1: Address physical health needs of the veteran Process Centered Assigned to proper medical provider Attend all medical and rehabilitation appointments Outcome Centered Physical condition of the veteran has impr oved (e.g., able to walk, recovered from surgery) Process & Impact Goal 1: Address relapse Process Centered Sanctions applied when and where appropriate and dependent upon individual cases o admonishment from the bench o written essay o increased frequency of court appearances o increased frequency of random drug screen o increased counseling o community service hours o increased self help meeting attendance o demotion to earlier program phase o placement in residential treatment facility o formal probation violation o brief i ncarceration Process & Impact Goal 1: Promote recovery Process Centered Rewards applied when and where appropriate and dependent upon individual cases o encouragement and praise from the bench o ceremonies o tokens of progress o advancement to next program phas e Process & Impact Goal 2: Create support system for the veteran through relationship with mentor (no veteran is left behind or forgotten) Process Centered Veteran: Is assigned a peer mentor Must attend meetings with mentor for encouragement, guidance, and support Veteran Peer Mentor Supports veteran in readjustment to civilian life Helps veteran navigate the system (the court,

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255 treatment, and VA) Attends court sessions and reports on veteran progress Lead mentoring sessions with veterans Act as a role mo del Outcome Centered Veteran feels the mentor is there for him/her in times of need Veteran feels the mentor supports him/her Veteran looks to mentor as a role model Mentor feels that he/she has made a difference in the veterans life Process & Impact Goa l 3: Accept responsibility for behavior Process Centered Make court appearances Attend treatment sessions Fulfill court and probation obligations Outcome Centered Acknowledge their issues Accept responsibility before the Court Compliant with the law Proc ess & Impact Goal 4: Prosecution and defense promote public safety and protect due process rights through a nonadversarial approach Process Centered Frequent status checks in court and VTC team meetings Outcome Centered Case remains in VTC Satisfy probati on obligations Satisfy court obligations (e.g., community service hours, restitution, obtaining drivers license/restoring driving privileges) Satisfy clinical obligations

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256 Table A 48 PBCVTC Case Study Structured Observation Instruments St ructured Observations Unit of Analysis VTC Team Meeting Team meeting VTC personnel VTC Team Meeting for Veteran Veterans discussed in team meeting VTC personnel VTC Session VTC session VTC personnel VTC session audience VTC Session for Veteran VTC personnel Veteran defendants VTC session audience

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257 Table A 49 PBCVTC Case Study Initial Interview Instruments Initial Interviews Unit of Analysis Veteran I Base Veterans starting participation in VTC during wave 1 of data collection Housing subsection (B) Substance abuse subsection (C) Mental health subsection (D) Veteran II Base Veterans already participating in VTC during wave 1 of data collection Housing subsection ( II B) Housing program subsection ( II B2) Substance abuse subsection ( II C) Substance abuse program subsection ( II C2) Mental health subsection ( II D) Mental health program subsection ( II D2) Opt Out Base Veterans opting out of VTC participation during wave 1 o f data collection Housing subsection (B) Substance abuse subsection (C) Mental health subsection (D) Drop Out Base Veterans dropping out of VTC after participating during wave 1 of data collection Housing subsection ( II B) Housing p rogram subsection ( II B2) Substance abuse subsection ( II C) Substance abuse program subsection ( II C2) Mental health subsection ( II D) Mental health program subsection ( II D2) Terminated Base Veterans terminated by the VTC during wave 1 of data collection Housing subsection ( II B) Housing program subsection ( II B2) Substance abuse subsection ( II C) Substance abuse program subsection ( II C2) Mental health subsection ( II D) Mental health program subsection ( II D2) Gra duate Base Veterans who graduated the VTC program during wave 1 of data collection Housing subsection ( II B) Housing program subsection ( II B2) Substance abuse subsection ( II C) Substance abuse program subsection ( II C2) Mental health s ubsection ( II D) Mental health program subsection ( II D2)

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258 T able A 50 Outcome R ate C ategories Categories Number Category 1 Interview Complete 79 Category 2 Eligible: Non interview Message not returned 19 Break off/Implicit re fusal 8 Other, nonrefusal 3 Non contact 3 Refusal and Breakoff 1 Location not allowing interview 1 Total 114 Table A 51 Rate E stimates Estimates Percent Response rate Response rate 1 (RR1) 69.3 Cooperation rate Coop eration rate 1 (COOP1) 85.1 Cooperation rate 3 (COOP3 ) 89.8 Refusal rate Refusal rate 1 (REF1) 7.9 Contact rate Contact rate 1 (CON1) 80.7 Table A 52. Reasons for Ineligibility Reasons Number (n=6) Conflict of Interest for PD 1 Fugitiv e Felon 1 Not enough time in service 1 Not a U.S. veteran 2 Case dismissed and put in residential treatment 1

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259 T able A 53. Participating and Nonparticipating Eligible V eterans by G roup (n=146) Group Participated (n=59) Refused outright (n=5) Init ially agreed but did not schedule (n=45) No Show (n=14) Unable to be interviewed (n=22) Excluded by researcher (n=1) Began participation in Wave I ( Group 1) 20 1 3 3 Already participating at Wave I ( Group 2) 26 1 9 8 15 Opt Out 7 1 7 Drop Out Terminated 1 1 1 3 Graduated 5 2 5 1 1 Unknown 23 2 Table A 54. Reasons for Nonparticipation by G roup (n=28) Reasons for Nonparticipation Group 1 Group 2 Opt out Graduated Terminated Outright Refusal Fed up with vet court 1 1 Just not interested and busy 1 2 Unable to be Interviewed In residential treatment in Wave I 3 3 Died 3 Incarcerated in Wave I 5 3 Deployed in Wave I 2 Resides outside of jurisdiction 2 1 I Declined to Interview Federal case pending and records 1

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260 T able A 55. Outcome R ate C ategories Categories Number Category 1 Interview Complete 59 Category 2 Eligible: Non interview Refusal by known res pondent 5 Non contact 8 Left voicemails 16 Miscellaneous non interview (no show) 12 Location not allowing interview (inpatient treatment, incarcerated, deployed, out of state) 19 Deceased 3 Other non refusal (excluded by researcher) 1 Category 4: Not Eligible Not eligible respondent 6 Total 129 Table A 56. Rate E stimates Estimates Percent Response rate Response rate 1 (RR1) 48.0% Cooperation rate Cooperation rate 1 (COOP1) 59.6% Cooperation rat e 3 (COOP3 ) 92.2% Refusal rate Refusal rate 1 (REF1) 4.1% Contact rate Contact rate 1 (CON1) 80.5%

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261 Table A 57. Interview Samples Demographics (n=59) Demographic Percent (n=59) Sex Male 94.9 % Female 5.1% Race/Ethnicity White (no n Hispanic) 55.9% African American 28.8% Hispanic 10.1% Asian, Pacific Islander Biracial 5.0%* Age 18 20 years of age 21 25 years of age 6.7% 26 30 years of age 8.4% 31 40 years of age 13.5% 41 50 years of age 11.8% 51 60 years of age 30.5% 61+ years of age 20.3% Missing 8.4% Education Level MD or DO 1.7% Masters degree 1.7% Bachelors degree 6.8% Associates degree 15.3% Some college 1.7% High school diploma 49.2% GED 13.6% Technical or trade degree 8.4% Certified nurse 1.7% Enrol led in School or Legally Employed Legally employed 20.2% Currently enrolled in school 10.2% In process of enrolling in school 1.7% Housing Status Living in residence you rent or own 57.6% Living in a housing facility 6.8% Living in a half way house 3.4% Living in an inpatient facility 1.7% Homeless 1.7% Number of Children None 35.6% One 18.6%

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262 Two 22.0% Three 6.8% Four 6.8% Five 3.4% Six or more 6.8% Marital Status Single 33.9% Engaged 1.7% Married 22.0% Separated 8.5% Divorced 27.1% Widowed 6.8% VJOs Evaluation Diagnosis Substance Abuse 45.8% Mental health 44.1% Homelessness 11.9% Physical health issues 5.1% Need benefits 1.7% Transportation 1.7% Mentoring 1.7% Does not apply never evaluated 22.0% Number of Diagnoses per Case None 11.9% One 28.8% Two 32.2% Three 5.1% Does not apply never evaluated 22.0% Three biracial = one Caucasian/Hispanic, one Caucasian/American Indian, one dont know

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263 Table A 58. Interview Samples Military Characteristics (n =59) Demographic Percent age Veteran Status Enlisted 1.7% Honorable Discharge 93.2% General Discharge on Honorable Conditions 1.7% General Discharge 3.4% Age Enlisted Less than 18 years of age 22.0% 18 years of age 30.5% 19 years of age 18.6% 20 years of age 10.2% 21 years of age 6.8% 22 years of age 3.4% 23 years of age 5.1% 32 years of age 1.7% 35 years of age 1.7% Branch Army 37.3% Navy 20.3% Air Force 18.6% Marine Corps 16.9% Army National Guard 3.4% Army Reserve 3.4% Era OIF /OEF/OND 20.3% Gulf War/Desert Storm 10.2% Post Vietnam 32.2% Vietnam 37.3% Combat and Deployment Served in a legally combat zone 39.0% Ever deployed (war or peace) 54.2% Were deployed in wartime 40.7% Injured Suffered any physical or mental inju ries 74.6% Discharged due to injuries 18.6%

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264 Table A 59. Sampling Frames Current Drug Offense Counts and Types Number of Drug Charge s Percentage of Veterans (n=129) No drug charges 65.1% One drug charges 26.4% Two drug charges 7.0% Three dru g charges 0.8% Four drug charges 0.8% Types of D rug C harge s Percentage of Drug Charges (n=59) Possession of schedule I substance* 35.5% DUI with damage/Enhanced or Felony DUI 16.9% DUI or DWI 10.1% Possession of paraphernalia 8.4% Possession of sch edule IV substance 6.7% Possession of oxycodone (schedule II) 3.3% Attempt to buy cocaine (schedule I) 3.3% Attempt to obtain controlled substance by fraud 3.3% Sale of schedule II substance 3.3% Possession of hydrocodone (schedule III) 1.6% Sale of schedule I substance (heroin) 1.6% Attempt to buy crack (schedule I) 1.6% Consumption of alcohol in public 1.6% Open container 1.6% *12 cocaine, 5 marijuana (<20g), 3 Ecstacy/MDMA, and 1 heroin possessions Table A 60. Sampling Frames Current Violent Offense Counts and Types Number of Violent Charge s Percentage of Veterans (n=129 ) No violent charges 80.6% One violent charges 14.0% Two violent charges 4.7% Three violent charges 0.8% Type of Violent C harge s Percentage of Violent Charges (n=32 ) D omestic battery 31.2% Battery 25.0% Battery on law enforcement/EMT/firefighter 18.7% Assault 12.5% Assault on law enforcement 6.2% Aggravated assault 3.1% Resist officer with violence 3.1%

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265 Table A 61. Sampling Frames Current Weapon Offense Counts and Types Weapons Charge Percentage of Veterans (n=129 ) No weapons charges 95.3% One weapons charges 3.9% Two weapons charges Three weapons charges 0.8% Types of Weapons C harge s Percentage of Weapons Charges (n=8 ) Illegal exhibition of firearm 7 5.0% Shooting into a building 12.5% Discharge firearm in public 12.5% Table A 62. Sampling Frames Current Property Offense Counts and Types Property Charge Percentage of Veterans (n=129 ) No property charges 82.2% One property charges 14.0% Two p roperty charges 3.1% Three property charges 0.8% Types of Property Charges Percentage of Property Charges (n=29 ) Grand theft 31.0% Petit theft/larceny 20.6% Retail theft 6.8% Grand theft auto 6.8% Burglary of structure/conveyance 6.8% Uttering 3.4% Burning lands 3.4% Burglary 3.4% Trespassing 3.4% Trespassing after warning 3.4% Trespass of a structure 3.4% Insurance fraud (<20k) 3.4% Fraudulent insurance claim 3.4%

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266 Table A 63. Sampling Frames Current Traffic Offense Counts and Types Number of Traffic Charge s Percentage of Veterans (n=129 ) No traffic charges 58.1% One traffic charges 14.7% Two traffic charges 11.6% Three traffic charges 6.2% Four traffic charges 4.7% Five traffic charges 2.3% Six traffic charges Se ven or more traffic charges 2.3% Types of Traffic C harge s Percentage of Traffic Charges (n= 137 ) Drivers license suspended/revoked/cancelled/none 43.7% No proof of insurance 14.5% Speeding 6.5% Failure to display registration 5.1% Expired registratio n 3.6% Failure to stop at red light 2.9% Ran stop sign 2.1% Reckless driving 2.1% Refusal to submit to chemical/physical test 2.1% Leaving scene of crash with damage 1.4% Attached tag not assigned 1.4% Failure to yield 1.4% Expired drivers license /wrong address 1.4% Seatbelt 1.4% Driving wrong way on one way 1.4% Driving vehicle in unsafe condition 1.4% Faure to drive in single lane .01% Failure to move over for emergency vehicle .01% Unregistered vehicle .01% Improper stopping/standing/par king .01% Unregistered vehicle .01% HOV violation .01% Moving steady yellow vehicular traffic .01% No reflector on motorcycle .01% Front seat passenger <18 yrs old not seatbelted .01%

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267 Table A 64. Sampling Frames Current Other Offense Counts and Types Number of Other Charge s Percentage of Veterans (n=129 ) No other charges 84.5% One other charges 14.0% Two other charges .08% Three other charges .08% Types of Other C harge s Percentage of Other Charges (n=22 ) Resisting without violence 36.3% Violation of injunction for DV 18.1% Criminal mischief 9.0% Giving a false name 4.5% Sex offense 4.5% Child abuse 4.5% Affray 4.5% Illegal use of shopping cart 4.5% Not willing to sign/accept citation 4.5% Pretrial release condition violation 4 .5% Organized scheme to defraud 4.5% Table A 65. Sampling Frames VA Eligibility Information (n=129) VA Eligibility Percentage of Veterans (n=129 ) Eligible 86.8% Ineligible 10.1% Do not know/still being determined 3.1% Reason for Ineligibility Per centage of Other Charges (n=13 ) Currently in custody 8 Not enough time in service 3 Fugitive felon 1 Less than honorable discharge 1

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268 Table A 66. Interview Samples Identification of Veteran Status Time from Arrest to Veteran Status Identif ication Percentage (n=58) Immediately (at arrest) 5.1% 48 hours 25.8% 3 7 days 1.7% 2 weeks 3.4% 3 weeks 12.0% 1 month 8.6% 2 months 5.1% 3 months 1.7% 4 5 months 5.1% 6 7 months 1.7% 2 years 1.7% Never 13.7% Do not know 13.7% Criminal Justi ce Stage Where Identification Occurred Percentage (n=58) Booking 15.5% First Appearance 46.5% Pretrial 3.4% Later Court Appearance 13.7% While incarcerated 3.4% Meeting with VJO 1.7% Never 13.7% Do not know 1.7% Identifying Agent Percentage (n=59 ) Public Defender 33.8% Judge 16.9% Law Enforcement Officer or Personnel 11.8% Court Personnel 10.1% Hired Attorney 5.0% VJO 3.3% No one 13.5% Do not know 5.0%

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269 Table A 67. Learning of and Transferring Cases to PBCVTC (Interview Sample) Stage of Process First Heard about PBCVTC (n=58) First Asked to Transfer Case (n=59) Before arrest 3.4% Booking 5.2% Between arrest/booking and first appearance 3.4% First appearance 44.8% 33.8% Pretrial 3.4% 1.6% Later court appearance 5.2% 6.7% Meeting with attorney (outside of court) 8.6% 6.7% Phone call from private attorney 5.1% 3.3% At first appearance in PBCVTC 3.4% 6.7% Meeting with probation officer 1.7% Meeting with VJO 1.7% 3.3% VA appointment 1.7% While incarcerated 5.2% 6.7% Do not know 5.1% 1.6% Never 28.8% Agent Public defender 31.0% 30.5% Judge 22.4% 22.0% Court personnel 6.8% 3.3% Someone at VA (not VJO) 6.8% Friend 5.1% Inmate 5.1% Media 5.1% Law enforcement officer 3.4% Private attorney 3.4% 6.7% VJO 3.4% 8.4% In booking package 1.7% ADA 1.7% Family member 1.7% Probation officer 1.7% 1.6% No one 27.1%

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270 Table A 68. VJO Evaluation Directive and Compliance Ever Told to Meet with VJO Percentage (n=58) Yes 67.8% No 30.5% Do not kn ow 1.7% When First Instructed to Meet VJO Percentage (n=40) Before first appearance 22.5% At first appearance 67.5% At second appearance 7.5% At third appearance 2.5% Ever Met with VJO Percentage (n=59) Yes 81.3 % When Meeting with VJO Took Place Percentage (n=48) Before first appearance 19.1% After first appearance 78.7% Do not know 2.1% Group Membership Told to Meet with VJO Group 1 (n=20) 65.0% Group 2 (n=26) 81.0% Graduated (n=5) 40.0% Opt out (n=7) 57.1% Terminated (n=1) Table A 6 9. Linking Veterans to Services (n=59) Type of Issue Diagnosed by VJO Linked to Related Service by VJO Veterans Already Participating in Related Service Substance abuse 45.8% 38.9% 5.1% Mental health 44.1% 23.7% 13.6% Housing services 11.9% 10.1% 1.7 % Physical health 5.1% 5.1% Benefits 1.7% 1.7% Transportation 1.7% 1.7% Does not apply (never evaluated or diagnosed) 22.0% 22.0% 22.0%

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271 Table A 70. Percentage of Diagnosed Veterans Connected to Services (n=46) Diagnosis by VJO Connected to S ervices by VJO Yes No No, Already Participating Substance abuse Yes 19 4 3 No 4 16 0 Mental health Yes 13 3 9 No 3 18 Housing services Yes 5 0 1 No 1 39 0 Table A 71. Veteran Satisfaction with VJO Linkage to Services Lev el of Satisfaction Percentage (n=46) Very satisfied 54.3% Satisfied 26.0% Neither satisfied nor dissatisfied 2.1% Dissatisfied Very dissatisfied Did not respond 17 .6% Table A 72. Frequency of Court Appearance by Group Currently Appearing Appe ared in Beginning Appeared at End Frequency Group 1 (n=20) Group 2 (n=26) Group 2 (n=26) Graduate (n=5) Graduate (n=5) Once a week 15.0% 3.8% Biweekly 15.0% 7.6% 20.0% Once a month 45.0% 42.3% 69.2% 40.0% 100.0% Once every 2 months 5.0% 34.6 % 15.3% Once every 3 months 5.0% 11.5% 3.8% Every 6 months 5.0% 3.8% Not been yet 10.0% Do not know 7.6% 40.0%

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272 Table A 73. Frequency of Participant and Current Mentor Communication by Method (n=21) Frequency Meet in Pers on (n=21) Talk on Phone (n=21) Electronic Communication (n=4) More than once a week 4.7% 4.7% 25.0% Once a week 9.5% 38.0% 25.0% Biweekly 9.5% 38.0% Three times a month 4.7% Once a month 42.8% 9.5% Once every other month 9.5% 25.0% Once ev ery four months 4.7% 25.0% Missing 14.2% 9.5% Table A 74. Frequency of Participant and Previous Mentor Communication by Method (n=3) Frequency Meet in Person (n=1) Talk on Phone (n=3) More than once a week 33.3% Once a week 100.0% 33.3% Biwe ekly 33.3%

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273 Table A 75. Process Goals Goals Performance Measures Location of Information Process Goal 1: Reach the target population Getting veterans with health or psychosocial issues into the program Interview and Structured Obse rvations Process Goal 2: Early veteran status identification and case transfer to VTC Veteran status known early (arrest, booking first appearance) Time to case placed on the VTC docket Interview Process Goal 3: Early evaluation by VJO Early evaluatio n with VJO (general eligibility, housing, mental health, substance abuse, medical) Interview Process Goal 4: Quickly link veterans to services based upon VJO evaluation VJO should be assigning veteran to treatment providers Treatment should correspond wi th results of the VJOs evaluation Interview Process Goal 5: Ongoing interaction between the VTC judge and the veteran Frequent cou rt appearances for status checks Structured Observations Process Goal 6: Ongoing interaction between the veterans and mento rs Frequent contact M entor provides encouragement, guidance, and support Interview Process Goal 7: Partnerships between the court, DOC, nonprofit organizations, and VA and community treatment providers Presence at team meetings Presence at court sessions Providing services Structured Observations Process Goal 8: VTC team working together in a nonadversarial manner Demeanor and dynamics in meetings and court o How confrontational team members were (and why) o How involved team members were (and why) o How re served team members were (and why) o How argumentative team members were (and why) Structured Observations

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274 Table A 76. Treatment Attendance for Veterans Appearing for First Status Check Occurring in Wave I Mental Health (n=55) Substance Abuse (n=58) Hou sing (n=3) Not Attending Treatment Sessions 7.27% 22.41% 33.33% Table A 77. Confrontation Levels of Team Members in Team Meetings Average Score Not at All (1) Somewhat (2) Mostly (3) Completely (4) Overall Meeting (n=7 meetings) 1.57 57.14% 2 8.57% 13.28% Judge (n=7 meetings) 1.14 85.71% 14.28% ADA (n=7 meetings) 1.71 42.85% 42.85% 14.28% Public Defender (n=7 meetings) 1.57 42.85% 57.14% VJO (n=5 meetings) 1.00 100.00% Probation DOC (n=6 meetings) 1.16 71.42% 14.28% Probation PRIDE (n=6 meetings) 1.16 71.42% 14.28% Community Treatment Provider (n=7 meetings) 1.00 100.00% Mentor Coordinator (n=3 meetings) 1.00 100.00%

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275 Table A 78. Levels of Reservation of Team Members in Team Meeti ngs Average Score Not at All (1) Somewhat (2) Mostly (3) Completely (4) Judge (n=7 meetings) 1.14 85.71% 14.28% ADA (n=7 meetings) 1.00 100.00% Public Defender (n=7 meetings) 1.28 71.42% 28.57% VJO (n=5 meetings) 1.00 100.00% Probation DOC (n=6 meetings) 1.16 83.33% 16.66% Probation PRIDE (n=6 meetings) 1.50 66.66% 16.66% 16.66% Community Treatment Provider (n=7 meetings) 1.14 85.71% 14.28% Mentor Coordinator (n=3 meetings) 1.00 100.00% Table A 79 Team Member Involvement in Team Meetings Average Score Not at All (1) Somewhat (2) Mostly (3) Completely (4) Judge (n=7 meetings) 3.85 14.28% 85.71% ADA (n=7 meetings) 4.00 100.0% Public Defender (n=7 meetings) 4.00 100.0% VJO (n =5 meetings) 4.00 100.0% Probation DOC (n=6 meetings) 4.00 100.0% Probation PRIDE (n=6 meetings) 3.33 16.66% 33.33% 50.00% Community Treatment Provider (n=7 meetings) 3.71 28.57% 71.42% Mentor Coordinator (n=3 meetings) 3.66 33.33% 66.66%

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276 Table A 80. Confrontation Levels Between Team Members in Court Sessions Average Score Not at All (1) Somewhat (2) Mostly (3) Completely (4) Judge (n=8 sessions) 1.12 87.50% 12.50% ADA (n=8 sessions) 1.87 25.0% 62.50% 12.50% Public Defender (n=8 sessions) 1.50 50.0% 50.0% VJO (n=5 sessions) 1.00 100.0% Probation DOC (n=8 sessions) 1.12 87.50% 12.50% Probation PRIDE (n=8 sessions) 1.00 100.0% Community Treatment Provider (n=6 sessions) 1.00 100.0% Mentor Coordinator (n=6 sessions) 1.00 100.0% Public Defender Drivers License (n=7 sessions) 1.00 100.0%

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277 Table A 81. Confrontation Levels Between Team Members and Veterans in Court Sessions Average Score N ot at All (1) Somewhat (2) Mostly (3) Completely (4) Judge (n=8 sessions) 1.37 62.50% 37.50% ADA (n=8 sessions) 1.62 37.50% 62.50% Public Defender (n=8 sessions) 1.25 75.00% 25.00% VJO (n=5 sessions) 1.00 100.00% Probation DOC (n=8 sessions) 1.00 100.00% Probation PRIDE (n=8 sessions) 1.00 100.00% Community Treatment Provider (n=6 sessions) 1.00 100.00% Mentor Coordinator (n=6 sessions) 1.00 100.00% Public Defender Drivers License (n=7 session s) 1.14 85.70% 14.28%

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278 APPENDIX B FIGURES Figure B 1 A Model of the Consequences of Post Deployment Mental Health and Cognitive Conditions (Tanielian et al., 2008:30)

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279 Figure B 2 National Survey Multi Phase Research Design

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280 Figure B 3 United States Census Regions (U.S. Census Bureau)

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281 Figure B 4 Map of Veterans Treatment Courts in Operation in the United States

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282 Figure B 5 Number of VTCs Established by Year (n=79 VTCs)

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283 Figure B 6 Supervis ing Agents Policy v. Practice

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284 Figure B 7 Evaluation of VTC Team Members (n=73 VTCs)

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285 Figure B 8 Evaluation of Agencies Working with VTC (n=72 VTCs)

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286 Figure B 9 Respondent Belief in Relationship between Military Experience and Personal Issues (n=71 VTCs) Figure B 10. Respondent Belief in Relationship between Personal Issues and Criminal Justice Contact (n=71 VTCs)

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287 Figure B 11. Respondent Belief in Relationship Military Experience, Personal Issues, and Criminal Justice C ontact (n=70 VTCs)

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288 Figure B 12. Program Requirement Difficulty Level by Sex (10 = Most Difficult)

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289 Figure B 13. Respondent Perceptions of Veteran Participants (n=72 VTCs)

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290 Figure B 14. Perceptions of Importance of Mentor Characteristics (0= Not Important at All, 10=Extremely Important)

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291 Figure B 15. Perceptions of Effectiveness (n=70 VTCs)

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292 Figure B 16. Perceptions of Impact and Goal Achievement (n=72 VTCs)

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293 Figure B 17. Veterans Status by Sex, Race, and Hispanic Origin 2009 (U.S. Census Bureau, 2009)

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294 Figure B 18. Veteran Living by Period of Service, Age, and Sex 2010 (U.S. Census Bureau 2010) [In Thousands (22,658 represents 22,658,000)]

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295 Figure B 19. Military Service Experiences of Responding Veterans (Westat, 2010:60)

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296 Figure B 20. Dendogram for Treatment Provider Orientation

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297 Figure B 21. Single Case Embedded Desig n

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298 Figure B 22. PBCVTC Logic Model

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299 Figure B 23. PBCVTC Service Utilization Plan

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300 Figure B 23 Continued PBCVTC Service Utilization Plan

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301 Figure B 24. Drug Court Locations in the United States and Tribal Lands (ONDCP, 2011:2)

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303 Figure C 1 National Survey Continued

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304 Figure C 1 Nation al Survey Continued

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305 Figure C 1 National Survey Continued

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306 Figure C 1 National Survey Continued

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307 Figure C 1 National Survey Continued

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308 Figure C 1 National Survey Continued

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309 Figure C 1 National Survey Continued

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310 Figure C 1 National Survey Continued

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311 Figure C 1 National Survey Continued

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312 Figure C 1 National Survey Continued

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313 Figure C 1 National Survey Continued

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314 Figure C 1 National Survey Continued

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315 Figure C 1 National Survey Continued

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316 Figure C 1 National Survey Continued

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317 Figure C 1 National Survey Continued

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318 Figure C 1 National Survey Continued

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319 Figure C 1 National Survey Continued

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320 Figure C 1 National Survey Continued

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321 Figure C 1 National Survey Continued

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322 Figure C 1 National Survey Continued

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323 APPENDIX D APPROVALS AND PROTOCOL Figure D 1 National Survey IRB Protocol

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324 Figure D 1 Continued. National Survey IRB Protocol

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325 Figure D 1 Continued. National Survey IRB Protocol

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326 Figure D 2 IRB Exemption Letter for National Survey

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327 Figure D 3 VJ O Access Letter

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328 Figure D 4 15th Judicial Circuit Court Administration Access Letter

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329 Figure D 5 Team Meeting Observation IRB Protocol

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330 Figure D 5 Continued. Team Meeting Observation IRB Protocol

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331 Figure D 5 Continued. Team Meeting Observati on IRB Protocol

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332 Figure D 6 Team Meeting Observation IRB Exemption

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333 Figure D 7 Open Court Observation IRB Protocol

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334 Figure D 7 Continued. Open Court Observation IRB Protocol

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335 Figure D 7 Continued. Open Court Observation IRB Protocol

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336 Figure D 8 VTC Open Court Observation IRB Exemption

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337 Figure D 9 Initial Interview IRB Protocol

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338 Figure D 9 Continued. Initial Interview IRB Protocol

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339 Figure D 9 Continued. Initial Interview IRB Protocol

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340 Figure D 9 Continued. Initial Interview IRB Protocol

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341 Figure D 9 Continued. Initial Interview IRB Protocol

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342 Figure D 9 Continued. Initial Interview IRB Protocol

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343 Figure D 9 Continued. Initial Interview IRB Protocol

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344 Figure D 9 Continued. Initial Interview IRB Pro tocol

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345 Figure D 9 Continued. Initial Interview IRB Protocol

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346 Figure D 10. Initial Interview IRB Approval

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347 Figure D 10 Continued Initial Interview IRB Approval

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348 Figure D 10 Continued Initial Interview IRB Approval

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349 Figure D 11. Follow up Interview IRB Protocol

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350 Figure D 11 Continued Follow up Interview IRB Protocol

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351 Figure D 11 Continued Follow up Interview IRB Protocol

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352 Figure D 11 Continued Follow up Interview IRB Protocol

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353 Figure D 11 Continued Follow up Interview IRB Protocol

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354 Figure D 11 Continued Follow up Interview IRB Protocol

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355 Figure D 12. Follow up Interview IRB Approval

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356 Figure D 12 Continued Follow up Interview IRB Approval

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357 Figure D 12 Continued Follow up Interview IRB Approval

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358 APPENDIX E SUPPLEMENTAL DOCUMENTS Figure E 1 VA Service Determination

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359 Figure E 2 House Bill 5214

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360 Figure E 3 VJO Contact Form

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361 Figure E 3 Continued VJO Contact Form

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3 62 Figure E 3 Continued VJO Contact Form

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363 Figure E 3 Continued VJO Contact Form

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364 Figure E 3 Continued VJO Contact Form

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365 Figure E 3 Continued VJO Contact Form

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366 Figure E 3 Continued VJO Contact Form

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367 Figure E 3 Continued VJO Contact Form

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368 Figure E 4 VJO Entry Form

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369 Figure E 4 Conti nued VJO Entry Form

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370 Figure E 4 Continued VJO Entry Form

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371 Figure E 4 Continued VJO Entry Form

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372 Figure E 5 Homelessness Assessment

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373 Figure E 5 Continued Homelessness Assessment

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374 Figure E 5 Continued. Homelessness Assessment

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375 Figure E 5 Continued Homelessness Assessment

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376 Figure E 5 Continued Homelessness Assessment

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377 Figure E 5 Continued Homelessness Assessment

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378 Figure E 5 Continued Homelessness Assessment

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379 Figure E 5 Continued Homelessness Assessment

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380 Figure E 5 Continued Homelessness Assessment

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381 Figure E 5 Continued Homelessness Assessment

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382 Figure E 5 Continued Homelessness Assessment

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383 Figure E 5 Continued Homelessness Assessment

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384 Figure E 6 Department of Veterans Affairs Medical Release

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385 Figure E 7 Administrative Order for the PBCVTC

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386 Figure E 7 Continued Administrative Order for the PBCVTC

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387 LIST OF REFERENCES Albin, M aurice S. 2001 The use of anesthetics during the Civil War, 18611865. Pharmacy in History 40: 99114. Aldwin, Carolyn M., Michael R. Levenson, and Avron Spiro. 1994. Vulnerability and resilience to combat exposure: Can stress have lifelong effects? Psychology and Aging 9 : 34 44. Anderson, A rthur. (Editor). 2007. The ASAP dictionary of anxiety and panic disorders. Retrieved on February 1, 2011 from American Psychiatric Association. 2000 Diagnostic and S tatistical M anual of M ental D isorders (Revised 4th ed.). Washington, DC: American Psychiatric Association. American Psychiatric Association. 2010 G 05 Posttra umatic s tress d isorder. Retrieved November 30, 2011, from APA DSM 5 Development website. Associated Press. 2004. 1 in 8 returning soldiers suffers from PTSD. Associated Press, 2004, June 30. Retrieved on July 2, 2010 from Acquaviva, G regory L. 2006. Mental health courts: N o longer experimental. Seton Hall Law Review 36: 971 1113. Akers, R onald L., and C hristine S. Sellers 2009 Criminological Theor ies: Introduction, Evaluation, and Application. New York, NY: Oxford University Press. Baar, Carl and Thomas A. Henderson. (1982). Alternative Models for the Organization of Court Systems. In Philip L. Dubois (Ed.), The Analysis of Judicial Reform. Lexingt on, MA: D.C. Health and Company. Baker, Dewleen G., Pia Heppner, Niloofar Afari, Sarah Nunnink, Michael Kilmer, Alan Simmons, Laura Harder, and Brandon Bosse. 2009. Trauma exposure, branch of service, and physical injury in relation to mental health among U.S. veterans returning from Iraq and Afghanistan. Military Medicine 174:773778. Baldwin, Julie M., and Joseph F. Spillane. Forthcoming. Theoretical complexities: Theories and models of behavior. Banks, Duren, and Denise C. Gottfredson. 2004. Participating in drug treatment court and time to rearrest. Justice Quarterly 21: 637 658.

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388 Barrett, Drue H., Michelle L. Green, Robin Morris, Wayne H. Giles, and Janet B. Croft. 1996. Cognitive functioning and posttraumatic stress disorder. American Journal of Psychia try 153:14921494. Beckerman, A dela, and Leonard Fontana 1989. Vietnam veterans and the criminal justice systems: A selected review. Criminal Justice and Behavior 16: 412. Beebe, T imothy J ., Patricia A. Harrison, and James A. McRae. 1999. Rural and urban differences in chemical dependency treatment: Results from the Minnesota Adult Household Survey. Minnesota Medicine 82: 1 5. Belenko, S teven. 1998 Research on drug courts: A critical review. National Drug Court Institute Review 1:1 42. Belenko, S teven. 199 9 Research on drug courts: A critical review: 1999 update. National Drug Court Institute Review II:1 58. Belenko, S teven. 2001 Research on D rug C ourts: A C ritical R eview, 2001 U pdate. New York: National Center on Addiction and Substance Abuse at Columbia University. Belenko, Steven. 2002. The challenges of conducting research in drug treatment court settings. Substance Use & Misuse 37: 16351664. Berman, Greg, and John Feinblatt. 2001. Problem solving courts: A brief primer. Law & Policy 23: 125 140. Berma n, Greg, and Anne Gulick. 2003. Just the (unwieldy, hard to gather but nonetheless essential) facts, ma am: What we know and don t know about problem solving courts Fordham Urban Law Journal 30:10271053. Berry, Frances Stokes and William D. Berry. (1990) State lottery adoptions as policy innovations: An event history analysis. American Political Science Review 84:395415. Berry, Frances Stokes and William D. Berry. (1992). Tax innovation in the states: Capitalizing on political opportunity. American Jour nal of Political Science 36:715742. Bjork, James M., and Steven J. Grant. 2009. Does traumatic brain injury increase risk for substance abuse? Journal of Neurotrauma 26:10771082. Bogacz, T ed. 1989 War neurosis and cultural change in England, 191422; The work of the war office committee of enquiry into shell shock. Journal of Contemporary History 24: 227256. Bongar, Bruce M., Lisa M. Brown, Larry E. Beutler, James N. Breckenridge, and Philip G. Zimbardo (Eds). 200 7 Psychology of Terrorism New York: Oxford University Press.

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389 Boothroyd, R oger A., Norman G. Poythress, Annette McGaha, and John P etrila. 2003. The Broward C ounty mental health court: Process, outcomes, and service utilization. International Journal of Law and Psychiatry 26: 5571. Bouffard, L eana A llen. 2003. Examining the relationship between military service and criminal behavior during the Vietnam era: A research note. Criminology 41: 491 510. Bouffard, L eana A llen. 2005. The military as a bridging environment in criminal careers: Differen tial outcomes of the military experience. Armed Forces & Society 31: 273 295. Bouffard, J effrey A., and Shamayne S mith. 2005. Programmatic, counselor, and client l evel comparison of rural versus urban drug c ourt t reatment. Substance Use & Misuse 40: 321 342. Bremner, J.D., S M. Southwick, A. Darnell and D.S. Charney. 1996 Chronic PT SD in Vietnam combat veterans: C ourse o f illness and substance abuse. American Journal of Psychiatry 153: 369 375. Brunello, Nicole, Johnathan R.T. Davidson, Martin Deahl, Ron C. Kessler, Julien Mendlewicz, Giorgio Racagni, Arieh Y. Shalev, and Joseph Zohar. 2001. Posttraumatic stress disorder: Diagnosis and epidemiology, comorbidity and social consequences, biology and treatment. Neuropsychobiology 43:150 162. Bryant, Alison L., J ohn Schulenberg, Jerald Bachman, Patrick M. OMalley, and Llyod Johnston. 2000. Understanding the links among school misbehavior, academic achievement, and cigarette use: A national panel study of adolescents. Prevention Science 1. Burns, Richard A., and R ichard Burns. 2009. Business research methods and statistics using SPSS London: SAGE Publications Ltd. Burton, Linda M. 1985. Early and ontime grandmotherhood in multigenerational black families. University of Southern California, Unpublished dissertati on. Caldeira, Gregory A. (1982). A tale of two reforms: On the work of the U.S. Supreme Court. In Philip L. Dubois (Ed.), The Analysis of Judicial Reform. Lexington, MA: D.C. Health and Company. Calhoun., P. S., J. R. Elter, E. R. Johnes, H. Kudler and K Straits Troster. 2008. Hazardous alcohol use and receipt of risk reduction counseling among U.S. veterans of the wars in Iraq and Afghanistan. Journal of Clinical Psychiatry 69: 16861693. Caplow, Theodore, & Jonathan Simon. 1999. Understanding prison pol icy and population trends. Crime and Justice 26: 63120.

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390 Card, Josephina J. 1983. Lives after Vietnam: The Personal Impact of Military S ervices. Lexington, MA: Lexington. Carey, Shannon, and Michael Finigan. 2003. A detailed cost analysis in a mature drug court setting: A cost benefit evaluation of the Multnomah County Drug Court. Retrieved on April 17, 2007 from ourt%20Cost%20Analysis%20Revised%20%20082603%20final.pdf. Carson, E. Ann and William J. Sabol. (2011). Prisoners in 2011 (NCJ 239808). Washington, D.C.: U S. Department of Justice, Bureau of Justice Statistics. Cartwright, Tiffany. 2011. To care for him who shall have borne the battle The recent development of veterans treatment courts in America. Stanford Law & Policy Review 22:295316. Clausen, John A. 1995. Gender, contexts, and turning points in adults lives. In Examining Lives in Context: Perspectives on the Ecology of Human Development, eds. Phyllis. Moen, Glen H. Elder Jr ., and Kurt Luscher. Washington, DC: APA Press. Corrigan, John D., and Thomas B. Cole. 2008 Substance use disorders and clinical management of traumatic brain injury and posttraumatic stress disorder. Journal of the American Medical Association 300: 720721. Council of State Governments. 2003. Mental health courts program Grant 2003DDBX K007, Bureau of Justice Assistance, Office of Justice Programs, U.S. Department of Justice. Counc il of State Governments. 2003. Mental health courts: A national s napshot. Grant 2003DDBX K007, Bureau of Justice Assistance, Office of Justice Programs, U.S. Department of Justice. Creswell, John W. 2013. Qualitative Inquiry & Research Design: Choosing from Five Approaches (3rd ed.). Thousand Oaks, CA: SAGE Publications Inc. Creswell, John W., and Vicki L. Plano Clark. 2011. Designing and Conducting Mixed Methods Research (2nd ed.). Thousand Oaks, CA: SAGE Publications Inc. Crouch, Ben M. 1993. Is incarceration really worse? Analysis of offenders preferences for prison over probation. Justice Quarterly 10:6788. Cullen, Francis T., and Robert Agnew. 2006. Criminological Theory: Past to Present 3rd Edition. Los Angeles, CA: Roxbury Publishing Company. Dane, Andrew V. and Barry H. Schneider. 1998. Program integrity in primary and early secondary prevention: Are implementation effects out of control? Clinical Psychology Review 18:23 45.

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409 BIOGRA PHICAL SKETCH In December of 2004, Julie Marie Baldwin graduated from the University of North Florida (Jacksonville, Florida) with a Bachelor of A rts degree in criminal justice with a minor in English. She graduated from John Jay College of Criminal Justic e (New York, New York) in May of 2007 with a Master of A rts degree in criminal justice with a specialization in criminal law and procedure. Her thesis was entitled Do Drug Courts Work? Following graduation, she worked as a paralegal and Freedom of Inform ation Law administrator for the Kings County District Attorneys Office (Brooklyn, N ew Y ork ) and then as a court analyst for the New York State Supreme Court Appellate Division, Second Judicial Department. Her pursuit of a doctoral degree led her to the Cr iminology, Law and Society degree program in the University of Floridas Department of Sociology and Criminology & Law. T he Souther n Criminal Justice Association named her Outstanding Graduate Student for 20122013. She has received the University of Flori da Graduate School Doctoral Research Travel Grant (2012) and the Gator Criminology Syndicates awards for Most Innovative Dissertation (2012, 2013), Outstanding Data Collection (2013), and Most Service to the Department (2011, 2012). She joins the faculty at the University of Arkansas at Little Rock in the Fall of 2013