eric bruns mike pullmann university of washington school of medicine

1

King County Family Treatment Court Evaluation

Grand Rounds—Division of Public Behavioral Health and Justice PolicyMarch 14, 2011

Eric BrunsMike Pullmann

University of Washington School of MedicineDivision of Public Behavioral Health and Justice

Policywww.uwhelpingfamilies.org

Jill MurphyMark Wirschem

King County Family Treatment CourtKing County Superior Court

http://www.uwhelpingfamilies.org/

2

Specialty and Therapeutic Courts• Problem-solving courts that aim to address the root causes of

criminal activity• Generally multi-system, coordinated, collaborative process which

balances supervision with support• “Therapeutic Jurisprudence Theory” (Wexler & Winich, 1991): using

social science to inform legal policy and practice in order to promote individual and societal well-being.

• Examples include:– Adult and juvenile drug treatment courts; – Family drug treatment courts;– Mental health courts;– Homelessness courts; – Prostitution prevention courts;– DUI courts;– Habitual offender courts;– Prison re-entry courts.

3

KCFTC PROCESSES AND FUNCTIONS•Comprehensive SB Assessment•High quality, appropriate CD Services•Timely/effective MH and other services•Effective care planning and management•Expanded and more frequent visitation•Consistent, timely incentives & sanctions•Random UA Screens•Effective pre-hearing case conferences•Effective judicial interaction

SHORT-TERM OUTCOMES•Eligibility/enrollment completed quickly•Enrollment in appropriate CD services•Parents compliant with/complete treatment•Parents ultimately able to remain sober•Parents/children more fully engaged in svcs•Parents/children receive needed services•Decreased placement disruptions•Parents compliant with court orders•Less negative effect on child well-being•Less disruption of child-parent bonds•Increased family reunification rates•Earlier determination. of alternate placement options

NATIONAL BEST PRACTICES•Communication bw Court and providers•Judge plays active role in Tx process•Judge responds to positive & noncompliant beh.•Mechanisms for shared decision making•Accountability for Tx services•Strategy for responding to noncompliance•MIS allow data to be assembled/reviewed•Enhancement of due process•Team members provided adeq resources

The King County Family Treatment Court

4

Placement in Shelter Care

Dependency Petition Filed

Shelter Care Hearing(w/in 72 hours of place-ment or filing, whichever

occurs first)

Pre-TrialConference(21 days prior to

fact-finding)

Fact-Finding Hearing

(w/in 75 daysof filing)

Disposition Hearing

(same day as or w/in 14 days of dep finding)

Review Hearing(the sooner of 90 days from Dispo. or 6 mos.

from date of placement)

Permanency Planning Hearing(12 months from date of placement & every 12

months thereafter)

Review Hearing(w/in 6 months after

permanency planning hearing)

PetitionApproved

DependencyContinued

Exit System

Yes

PermanencyGoal Achieved?

Yes

PermanencyGoal Achieved?

Petition forParental Rights Termination?

No

No

Petition forParental Rights Termination?

No

No

Petition for Termination of Parental Rights

Filed

Yes

Yes

PetitionDismissed

PetitionDismissed

PetitionDismissed

PetitionDismissed

30-Day Shelter Care Review(w/in 30 days of

placement)

Shelter Care Case Conf.(30 days prior to

fact-finding)

PetitionDismissed

Dept. supervision

continues for 6 mos.

Childreturned

home

Review Hearing

PetitionDismissed

Dependency Stipulated

Enter FTC*(See separate

flow chart)

Enter FTC*(See separate

flow chart)

Exit FTC w/o Permanency Goal Achieved

Exit FTC w/o Permanency Goal Achieved

Original Chart prepared by Michael Curtis on January 12,

2006

*There can be entry into FTC anytime after dependency is established as long as a referral is made to FTC within 6 months of the filed petition date.

*There can be entry into FTC anytime after dependency is established as long as a referral is made to FTC within 6 months of the filed petition date.

Juvenile Dependency Case Flow (noting FTC)

5

FAMILY TREATMENT COURT CASE PROCESSING FLOW CHART

Check In Hearing: Set for following week after positive/missed UA or noncompliance w/ tx

Compliance Clock Hearing: Can be applied

after 5th response and set 60 days out from

current hearing

Motion Hearing: Can be set anytime there is a contested issue. Not

heard during regular FTC calendar

Discharge/Opt Out Hearing: Dependency

dismissed or discharged

to regular dependency

Other FTC Hearings:

Box Color Legend:

Red: Not a hearing

Green: Beginning and end of FTC Process

Blue: FTC Review Hearings

Graduated Blue: Does not occur on every case

Orange: Not unique to FTC

Purple: Unique to FTC and can occur throughout FTC process

Summary of the FTDC Literature(ca. 2008)

• Now three studies of FTDC model (Green et al., Boles, NPC Research)

• All three studies show positive outcomes:– Less reliance on foster care– Greater reunification rates (e.g., 42% vs. 27%; 70% vs. 45%)– Higher rates of treatment engagement and completion

• No study found between-group differences in future abuse/neglect reports

• NPC Research, the most active evaluators of FTCs and drug treatment courts, has completed several cost-benefit analyses at sites across the nation. The table below summarizes their findings:

Location Cost savings per participant

Return on investment

Areas of savings[1]

Harford Co., MD $12,000 over 1 year 350% Foster care days, Criminal justice, Court Cases

Jackson Co., OR $5,593 over 4 years 106% Foster care days, Probation/Parole, Court Cases

CA "Court 1" $1,657 over 4 years 130% Not provided

CA "Court 2" $2,141 over 5 years Not provided Not provided

Baltimore, MD $5,022 over 1 year Not provided Foster care days (did not examine other areas)

7

Components of the KCFTC Evaluation

• Process evaluation– Interviews with team members and

stakeholders, 2006 and 2008– Parent interviews, 2007-2009

• Outcomes evaluation– Analysis of child placement data from Children’s

Administration and adult treatment data from the Division of Behavioral Health and Recovery

• Cost-benefit analysis– Currently underway

8

What we learned from process evaluation

• Strengths– Strong opinions about the positive impact of KCFTC– Most processes and functions viewed as successfully being

accomplished by 2008• Relative Weaknesses

– Respondents less confident that goal of serving a representative population was being met

– Respondents believed client load was less than optimal (serving too few families)

– Mixed opinions on the amount of shared vision among team members

– Certain processes and functions:• Efficiency of eligibility determination and intake• Consistency and effectiveness of incentives and sanctions• Resources and training for KCFTC staff and team members

0%

5%

10%

15%

20%

25%

30%

35%

40%

Overall Success compared to regular dependency court"Compared to the regular dependency court process, how succesful do you

think KCFTC is in accomplishing these overall goals for participating families?"

2006-2008 (n=37, 36)

2006 0% 5% 11% 19% 27% 24% 14%

2008 0% 3% 11% 6% 19% 39% 22%

Much less successful

Somewhat less

successful

About the same

A little bit more

successful

Somewhat more

successful

A good deal more successful

Much more

successful

2006: Mean= 5 Std. Dev= 1.4

2008: Mean= 5.47 Std. Dev= 1.36

Summary of Process and Function Questions

Means

2 2.5 3 3.5 4 4.5 5

Effective judicial interaction

Training and education for FTC staff

Effective pre-hearing case conferences

Random UA screens

Consistent, timely incentives and sanctions

Expanded and more frequent visitation

Care planning and management

Timely/ effective other services (children)

Timely/ effective other services (parents)

High quality, appropriate CD services

Comprehensive SB Assessment

2006

2008

A little bit

successful

Somewhat

Successful

Moderately

successful

Extremely

successful

Summary of Outcome QuestionsMeans

3 3.5 4 4.5 5 5.5 6

Early determination of alternate placement options

Increased family reunification rates

Less disruption of child/ parent bonds

Parents compliant with court orders

Decreased placement disruptions

Parents/ children receive services they need

Parents/ children more fully engaged in services

Ultimately able to be and remain sober

Parents compliant with/ complete treatment

Enrollment in appropriate CD services

2006

2008

About the same A little bit more successful

Somewhat more successful

A good deal more successful

What we learned from parent interviews

• High overall satisfaction with the process• Overall perception that court process and

treatment services are helpful• Some confusion among parents about

requirements of court, completing treatment plan, and regaining custody– Parents of color more likely to voice confusion

• Certain types of needed services to be available were difficult to access– Housing, child care, employment

12

Treatment Program is Helpful (n=28)“This treatment program can really help you.”

0%

10%

20%

30%

40%

50%

60%

70%

80%

All Parents 4% 0% 21% 75%

Strongly disagree Disagree Agree Strongly agree

Mean= 3.68 Std. Dev= .670

Court System Helps with Recovery (n=28)“There are people involved in the court system who help me in my recovery.”

0%

10%

20%

30%

40%

50%

60%

70%

All Parents 4% 0% 29% 68%

Strongly Disagree

Disagree AgreeStrongly

Agree


nn YesYes NoNo nn YesYes NoNo nn HelpfulHelpful(Mean Rating)(Mean Rating)

TransportationTransportation 227770%70% 30%30% 1919 90%90% 10%10% 1616 4.444.44

HousingHousing 227767%67% 33%33% 1818 50%50% 50%50% 99 4.674.67

Health insuranceHealth insurance 227752%52% 48%48% 1414 86%86% 14%14% 1212 4.584.58

Services for your children Services for your children (i.e. medical or counseling services)(i.e. medical or counseling services)

227741%41% 59%59% 1111 82%82% 18%18% 99 4.444.44

Parenting classesParenting classes 227748%48% 52%52% 1313 77%77% 23%23% 99 4.444.44

ChildcareChildcare 227726%26% 74%74% 77 57%57% 43%43% 44 3.753.75

Help finding employmentHelp finding employment 227722%22% 78%78% 66 67%67% 33%33% 44 2.252.25

Financial assistanceFinancial assistance 227756%56% 44%44% 1515 73%73% 27%27% 1010 3.503.50

Mental health servicesMental health services 227737%37% 63%63% 1010 80%80% 20%20% 77 4.004.00

Substance abuse assessmentSubstance abuse assessment 227726%26% 74%74% 77 100%100% 0%0% 66 4.504.50

Substance abuse treatment servicesSubstance abuse treatment services 227756%56% 44%44% 1515 100%100% 0%0% 1313 4.544.54

Medical services/medicationMedical services/medication 227730%30% 70%70% 88 75%75% 25%25% 55 4.004.00

In the past 30 days, have you needed any of the following services?If yes, did you obtain the service?If service was obtained, how helpful was it?1=Not at all helpful -- 2=A little helpful -- 3=Somewhat helpful -- 4=Very helpful --5=Extremely helpful

Needed Received

Clear Understanding About Regaining Custody (n=23)

“I have a clear understanding about what I need to do to have my child[ren] returned to me.”

0%

10%

20%

30%

40%

50%

60%

All Parents 9% 17% 17% 57%

Strongly Disagree


Agree

Mean= 3.22 Std. Dev= 1.043

Confused About What is Happening with my Child (n=26)

“I am confused about what is happening with my child[ren].”

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

All Parents 31% 46% 15% 8%

Strongly Disagree


Agree


18

Outcome Evaluation:Research Questions

1. Do FTC participants have more positive substance abuse treatment outcomes than comparable non-FTC parents?

2. Do FTC families have more positive child welfare outcomes compared to comparable non-FTC families?

3. Do families of color have outcomes similar to families not of color?

19

Outcome Evaluation

• Administrative data: – Treatment data from Division of Behavioral Health and Recovery – Child welfare data from Children’s Administration– Data collected September 2010

• Family Treatment Court group:– Selected all parents admitted to the FTC between March 2006

and October 2009

• Comparison group:– Eligible parents referred but not admitted to the Family

Treatment Court– Randomly selected a reasonable number– Statistically matched on demographics, historical treatment use,

and historical child welfare referrals

20

Reasons why parent is in comparison group

Percent

Attorney not responding 42%

Over 6 months without referral 18%

Chose not to participate 8%

No known address/can’t locate/on run 7%

Other 8%

Reason missing 17%

21

44%

1%

6%

1%3%

1%

7%

1%

14%

23%

56%

15%

40%

59%

18%

Parentwhite

Parent ofcolor

AfricanAmerican

AmericanIndian

Asian Hispanic PacificIslander

Missing

Comparison

FTC

Parent mean age• Comparison = 31• KCFTC = 31

Mean # of children per participant• Comparison=1.39• KCFTC = 1.46

Detail: specific race/ethnicity

Total # of parents = 268• Comparison = 182• KCFTC = 76

Parent demographics

Note: no significant differences

22

Prior Investigations

Comparison %or Mean (SD)

KCFTC %or Mean (SD)

Any investigation completed prior to petition 83% 79%

Type of Allegation (index petition)

Neglect 83% 77%

Abuse 36% 36%

Prenatal Injury 8% 9%

Medical Neglect 8% 7%

Abandonment 2% 3%

Number of investigations prior to petition 2.1 (2.1) 1.8 (2.3)

Note: No statistically significant differences

23

50%

4%

10%

2%

26%

6%

1%

17%

50%

35%32%

38%

54%

46%

28%

Female Male White AfricanAmerican

Asian/PI NativeAmerican

Hispanic Unknown

Comparison

FTC

Child Mean Age• Comparison = 4.2• KCFTC = 3.5

Number of children• Comparison = 235• KCFTC = 89

Child demographics

Note: Statistically significant difference for Native American

24

Status of FTC parent at time of data collection

FTC(n=76)

Discharged 33%

Graduated 26%

Currently enrolled 22%

Opted out of program 11%

Certificate of participation 7%

Dismissed 1%

25

Note on Analytic Approach…• 1). “Intent to treat”

– All parents who were admitted to FTC were included in all analyses, even if they opted out or had an unsuccessful outcome.

• No parent who was ever in FTC was ever included in the comparison group

• 2). Index Petition Date– “Time Zero” or comparable start point for both groups

was the petition date, not date of entry into FTC (comparison group had no date of entry)

These decisions likely result in more conservative findings

26

• Question 1: Do FTC participants have more positive substance abuse treatment outcomes than comparable non-FTC parents?– Are they more likely to enter treatment?– Do they enter treatment more quickly?– Are they more likely to attend treatment?– Do they remain in treatment longer?– Are they more likely to be successfully

discharged from treatment?

27

FTC parents are more likely to enter treatment

40%

20%

53% 52%59%

32%

88%84%

Admittedprior topetition

In treatmentat petition

Admittedafter

petition

Received txafter

petition

Comparison

FTC

Note: All differences statistically significant

FTC parents were 63% more likely to be admitted to treatment.

28

FTC parents enter treatment twice as fast

(Of those entering treatment, n=165)

Of those parents entering treatment who were not already in treatment at the index petition, the median days until treatment entry were:

• Comparison: 115

• KCFTC: 51

Note: Statistically significant difference, p < .05

Pro

por

tion

not

adm

itted

29

FTC parents received broader service array

Of those admitted to any treatment

Comparison(n=94)

KCFTC(n=66)

Long term Residential* 40% 65%

Intensive Outpatient 52% 56%

Outpatient 43% 50%

Intensive Inpatient 40% 35%

Methadone 17% 27%

Recovery House* 1% 9%

Housing Support 8% 3%

* Statistically significant difference, p < .05

30

FTC parents received broader service array

Of those who received any treatment

Comparison(n=94)

KCFTC(n=64)

Individual therapy* 89% 100%

Group therapy 90% 97%

Case management 81% 89%

Urinalysis 43% 52%

Methadone/opiate subst. 15% 25%

Childcare* 11% 25%

* Statistically significant difference, p < .05

31

FTC parents receive more treatment and are

more likely to attend treatment (Of all treatment events)

Comparisonn=6,188

FTCn=8,357

Attended treatment episode 87% 90%

Excused by provider 6% 4%

No show, unexcused 8% 6%


Avg. # of treatment events per person who received treatment:

• KCFTC = 145

• Comparison = 65

32

Success in treatment

• FTC parents remained in treatment twice as long (median of 109 days compared to 53)

• FTC parents 37% more likely to be successfully discharged from treatment (74% compared to 54%)

33

• Question 2: Do FTC families, compared to similar families who did not receive FTC services, have more positive child welfare outcomes? Specifically:– Do the children of FTC participants spend less time in

out of home placement?– Are the children of FTC participants placed in

permanent living situations more quickly overall?– Are FTC children more likely to have a permanent

placement?– Are FTC participants less likely to have subsequent

CPS referrals?

34

Child welfare outcomes

• FTC children spent 30% less time in out-of-home placements (median of 481 days, compared to 689 for comparison group)

• FTC children spent 20% less time in the child welfare system (median of 729 days, compared 819 for comparison group)

• FTC children 43% more likely to have a permanent placement (60% compared to 42%)

• FTC children 70% more likely to return to the care of their parent (58% compared to 34%)

35

Comparisonn=235

KCFTCn=89

Trial home visit 10% 17%

Reunification 9% 11%

Dependency dismissed 15% 30%

Adoption 14% 18%

Guardianship 4% 1%

Other 3% 1%

In out-of-home placement 46% 21%

34% 58%

Return home

42% 60%

Permanent placement

Permanent placements & returns home more likely for FTC children

36

Question 3: Do families of color have outcomes similar to families

not of color?

37

52%

87%

56%

90%

Comparison FTC

Parent white

Parent white

Parent of

color

Parent of

color

Parents of color did not differ from white parents in their likelihood to:

• Be in treatment when petition was filed

• Be admitted to treatment after petition

• Schedule treatment episode after petition is filed


Admitted to treatment through DBHR after petition

All parents

38

Note: White-white, p < .05

POC-POC, p < .10

81

5149

152

Comparison FTC

Parent white

Parent of color

Parent white

Parent of color

Median days until treatment entry

Of those not in treatment at petition

39

Median days in first treatment


POC-POC, p < .10

FTC: POC-White mixed

43

77

151

53

Comparison FTC

Parent white Parent

of color

Parent white

Parent of color

40

Length of time in first treatment episode

Of those parents entering treatment, the median days in first treatment episode:

• Comparison, parent of color: 43

• Comparison, white: 53

• KCFTC, parent of color: 77

• KCFTC, white: 151


41

Percentage successfully completing a treatment episode

Of those receiving treatment

Note: POC-POC p < .05

No other significant differences

52%

68%

55%

82%

Comparison FTC

Parent white

Parent white

Parent of

color

Parent of

color

42

Percentage of children with permanent placements

Note:

All: Comp-FTC p < .05


45%

66%

41%

57%

Comparison FTC

Child white

Child of color

Child white

Child of color

43

Percentage of children remaining in out of home placement

Note:


FTC: COC – Child white, p < .10


45%

11%

47%

28%

Comparison FTC

Child white

Child of color

Child white

Child of color

44

Comparing FTC to regular court for families of color

• Generally indicate that families of color in FTC had more positive outcomes than families of color in the comparison group– 61% more likely to enter treatment– Enter treatment 63% faster– Remain in treatment nearly twice as long– 49% more likely to complete treatment– Children 39% more likely to be permanently placed– Children 54% more likely to be returned home

45

Comparisons by race in FTC

• Parents of color in the FTC were not significantly different than white parents on:– Percentage admitted to treatment– Speed of admission to treatment– Percentage successfully completing treatment

• Parents of color spent less time than white parents in treatment

• Children of color might be more likely to remain in out-of-home placements (borderline significance)

46

Summary and conclusions• The King County Family Treatment Court is one of a

variety of problem-solving courts• Staff from several disciplines and agencies collaborate

on supervision and support• Stakeholders generally have positive opinions about the

development and functioning of the court• Parents have more successful substance use treatment

outcomes• Children are more likely to exit the child welfare system

and be returned to the care of their parents

47

Please contact us with any questionsEric Bruns

[email protected]

Mike Pullmann

[email protected]

Jill Murphy

[email protected]

Mark Wirschem

[email protected]

mailto:[email protected]




48

Extra slides

49

Median days until treatment entryAll parents


POC-POC, p < .05

Comp White – Comp POC, p < .05

No differences for FTC groups

215

2843

487

Comparison FTC

Parent white

Parent of color

Parent white

Parent of color

50

Median days until end of child’s out of home placement


POC-POC, p < .10

792 764

630651

Comparison FTC

Child white

Child of color

Child white

Child of color

51

Percentage of children returning home

Note:



31%

66%

35%

54%

Comparison FTC

Child white

Child of color

Child white

Child of color

52

Parent Primary Drug of Choice

Comparison % KCFTC %

None listed/not in DBHR dataset 54% 30%

Alcohol 8% 15%

Cocaine 12% 16%

Heroin 7% 16%

Marijuana/Cannabis 7% 3%

Methamphetamines/amphetamines 7% 13%

Other 6% 8%

Note: Groups significantly differed, p < .05

53

Statistical controls

• Because the groups differed slightly at petition date, in many analyses we controlled for:– Caregiver age– Caregiver race– Child age– Number of prior investigations– Whether parent was in treatment at admission– Number of prior treatment episodes– Primary drug of choice

54

FTC parents enter treatment more quickly


55

FTC parents remain in treatment longer


56

FTC children spend less time in out-of-home placements


57

FTC children are placed in permanent situations more quickly


58

Parents of color differ on speed at admission to services

Of all parents, the median days until treatment entry were:






POC-POC, p < .05

59

Parents of color differ on speed at admission to services

Of those parents entering treatment who were not already in treatment at the index petition, the median days until treatment entry were:






POC-POC, p < .10

60

Children of color do not differ in length of time in out of home

placementMedian days until end of out of home placement were:

• Comparison, youth of color: 792


• KCFTC, youth of color: 764


Note: White-White p < .05


61

Children of color differ on permanent placement type

Comparisonyouth of

color n=150

Comparisonwhite

n=85

FTCyouth of

colorn=54

FTC, white

n=35

Trial home visit 12% 6% 13% 23%

Reunification 11% 7% 15% 6%

Dependency dismissed

13% 18% 26% 37%

Adoption 13% 15% 17% 20%

Guardianship 6% 5% 0% 3%

Other 1% 5% 2% 0%

In out-of-home placement

47% 45% 28% 11%

62

Children of color differ on permanent placement type

Comparisonyouth of

color n=150

Comparisonwhite

n=85

FTCyouth of

colorn=54

FTC, white

n=35

Permanent placement 41% 45% 57% 66%

Returned home 35% 31% 54% 66%

In out-of-home placement

47% 45% 28% 11%


YOC-YOC p < .05


63

Children of color differ slightly in length of time until permanent

placementMedian days until permanent placement were:

• Comparison, youth of color: 866


• KCFTC, youth of color: 763



YOC-YOC p < .10


eric bruns mike pullmann university of washington school of medicine

Documents

court casesca court

court casesjackson

providedca court

adult treatment data

ftc processsummary

end of ftc processblue

division of behavioral

criminal justice