Drug Treatment Court Funding Program, Summative Evaluation

Appendix A - Summary of Canadian Drug Treatment Courts

Summary of Canadian DTCs
Opening date Toronto (TDTC)
December 1998		 Vancouver (DTCRCV)
December 2001		 Edmonton (EDTCRC)
December 2005		 Winnipeg (WDTC)
January 2006		 Ottawa (DTCO)
February 2006		 Regina (RDTC)
October 2006
DTC team Staff of the TDTC include a CAMH manager, court liaisons, therapists, program assistants, a psychologist, a nurse practitioner, a medical review officer, pharmacists, and a pharmacy technician.

(Process evaluation)

The court team includes a federal judge, federal and provincial Crowns, duty counsel, a Crown paralegal, probation, and representation from the bail program.

(Outcome evaluation)		 The DTCRCV court team includes two judges, a federal Crown and a duty counsel.

BC Corrections provides probation officers/case managers and the director of the program.

The treatment team (provided by Vancouver Coastal Health) includes a clinical supervisor, a physician, a psychologist, an addictions nurse, treatment therapists, and an addictions services manager. There is also an Aboriginal support worker, an employment and assistance worker, and an administrative assistant.		 The EDTCRC team includes the EDTCRC Judge, the Executive Director, a Probation Case Manager, a Treatment Case Manager, the assigned provincial and federal prosecutors, defence counsel and assigned duty counsel, the assigned paralegal, and designated service providers who work closely with the participants.

(Outcome evaluation 2008)		 The WDTC has a staffing model consisting of one Manager, three Counsellors, one administrative assistant, and one Probation Officer/Case Manager.

The legal team includes a dedicated judge, Federal Counsel, and Legal Aid Representative. Provincial matters are referred by various defence counsels and screened by various provincial Crowns. One Senior Crown acts as a liaison and referral to all provincial Crowns.

(Outcome evaluation January 2009)		 The team includes the Director, the Clinical Manager, the Court Liaison, two Probation Officers, judges prepared to sit in drug treatment courts (primaries and alternates), provincial and federal Crowns, duty counsel, and a paralegal.

(Outcome evaluation)		 The treatment team of the RDTC includes a program coordinator, an addictions psychiatric nurse, two addictions counsellors, a cultural liaison, a probation officer, a social worker, and administrative assistants. The legal team includes the judge, the Crown, and defence counsel.

(Outcome evaluation)
Eligibility requirements The judge decides who is eligible for the program in consultation with the treatment team and Crown prosecutor, according to these guidelines:
  • Must have clinically demonstrated addiction and criminal activity associated with that addiction.
  • Must not have violent and/or commercial drug trafficking convictions or mental health concerns that would interfere with their participation in the program.
  • Applicants with provincial charges may not be eligible.
  • Must not have involved anyone under the age of 18 in the offense.
The outcome evaluation mentions some but not all of these criteria.

According to the outcome evaluation, all applications are vetted by the Crown.		 Participants in the DTCV must meet these requirements:
  • The applicant's offence must be addiction-motivated; offenders who have committed crimes for profit are not eligible.
  • Offences must not have involved anyone under 18, and cannot have been committed when children were present.
  • Applicants with a history of violent offences may be ineligible if risk of violence is too high.
  • Degree of substance abuse problems, participant motivation, fit with existing group, and general suitability of the individual for the treatment regime are also considered.
 In an initial screening process, the Crown determines whether the participant meets the following criteria:
  • Current charges must be non-violent, motivated primarily by personal drug use rather than for commercial profit, and must not involve children or have occurred near where children frequent.
  • Exclusion criteria include known gang connections, a history of violence, motor vehicle-type offences, and a pattern of judicial non-compliance (i.e., failure to appear before the court in the past or breaching bail).
If applicants pass the initial Crown screening, they also complete an intake interview and addictions assessment by EDTCRC Case Managers. At these stages, the nature and severity of their addiction, previous treatment efforts, motivation to change, and overall suitability for the program are considered.

(Outcome evaluation 2008)		 The WDTC is available to offenders who meet both clinical and legal criteria.
  • Offender must be dependent on drugs.
  • The criminal behaviour must have been motivated by the addiction.
  • Violent offenders and gang members are not eligible.
  • Offences involving children are not eligible.
  • Persons who used a weapon to commit the offense are not eligible.
Depending on the severity of the offence, clients may be admitted to Track 1 (less serious) or Track 2 (more serious).

(Process evaluation)		 There are seven specific criteria for entry into the DTCO:
  1. Individual must plead guilty and consent to actively participate in treatment and drug tests.
  2. Individual must be charged with certain non-violent offences.
  3. Offences must have been motivated by/connected to drug dependence.
  4. Crimes must not have been profit-motivated.
  5. Individual must not be a risk to public safety.
  6. Individual must not be subject to a conditional sentence.
  7. Crown sentencing position must be less than two years.
(Process evaluation)		 Eligibility for the RDTC is based on six criteria:
  1. Circumstances of the crime – type of victim, location, apparent intent.
  2. Seriousness of the crime.
  3. Violence – whether the crime itself involved violence and whether the offender has a history of violence.
  4. Offence characteristics – whether the offence was gang-related or involved children.
  5. Type of crime – the exact nature of the crime and how drugs were involved.
  6. Criminal history – what kind of crimes the offender has committed in the past and whether violence has been involved.
(Process evaluation)
Treatment activities Participants go through a structured outpatient program with various stages specifically designed for people with cocaine or opiate addictions. Treatment includes:
  • group and individual counselling
  • ongoing case management
  • regular and random drug screening
  • addiction medicine services
Treatment staff work closely with community organizations to meet the needs of participants

(Process evaluation)		 Participants go through a five-phase, gender-specific treatment program, which includes:
  • individual and group counselling
  • regular drug testing
  • participation in supportive treatment activities
  • participation in self-help programs (e.g., Narcotics Anonymous)
  • voluntary methadone program
Treatment staff work closely with community organizations to meet the needs of participants.		 The treatment program offered by the EDTCRC lasts from 8 to 18 months. The program is based on an I-TRIP created in consultation with case manager, and includes:
  • regular court appearances
  • random drug testing
  • case managers meetings with participants at least once a week to provide supportive counselling and supervision
  • referrals to community supports
  • education or employment training
(Process evaluation)		 WDTC uses a stand-alone biopsychophysical, client-centred model with six phases:
  1. Referral
  2. Orientation/ assessment
  3. Stabilization
  4. Intensive treatment
  5. Maintenance
  6. Graduation
The approach to treatment accepts the inevitability of some relapses during the treatment period.

(Process evaluation)		 Treatment involves:
  • formal addiction group sessions
  • individual therapy sessions
  • residential and outpatient treatment programs
  • case management services
  • health and social services
  • random urine testing
In fall 2008, Phase I of the program was divided into A and B groups. "A" group consists of new participants, who participate in treatment groups focused mainly on stabilization of substance use, changing criminal thinking and life skills. After three or four months, participants progress on to the "B" group which focuses on developing insight into their addiction and behaviours. At this point participants are also expected to become involved in educational or employment activities. The "B" group lasts for approximately two months.

Phase II of the program consists of more intensive employment or educational activities and less intensive treatment activity.

(Outcome evaluation)		 Treatment includes 5 parts: assessment followed by 4 sequential tracks:
  1. Assessment
  2. (Track 1) Transition
  3. (Track 2) Stabilization
  4. (Track 3) Extended stabilization
  5. (Track 4) Relapse prevention
(Process evaluation)
Length of treatment program Approximately one year

(Outcome evaluation)		 265 clinic hours Participants are generally expected to spend between 8 and 18 months in the program. Participants are expected to spend between 12 and 18 months in the program. Program engagement can last over a year, and program requirements (number of court appearances or treatment sessions) can be reduced at any point during the treatment period.

(Process evaluation)		 The program requires a total of 274 hours of participation.

(Process evaluation)
Treatment providers The majority of treatment is provided by the Centre for Addiction and Mental Health

(Process evaluation)		 Vancouver Coastal Health provides assessment, case planning and delivery of treatment. Participants are referred to pre-existing day or residential treatment programs, as necessary. Unlike other DTCs, there is no single treatment provider. Day programs are provided by AADAC, Taking Charge, Herb Jamieson Break Out program, and Anchorage.

(Process evaluation)		 The program has made substantial use of the Behaviour Health Foundation for treatment services as well as self-help groups like Narcotics Anonymous; however, most of the treatment is provided by staff.

(Process evaluation)		 Most of the treatment is provided by Rideauwood Addiction and Family Services; however, additional treatment is provided by the Elizabeth Fry Society, the John Howard Society, Ontario Works - Addiction Services Initiative, and Somerset West Community Health Centre

(Process evaluation)		 Treatment services are provided mainly by the program itself. Participants are referred to other service agencies as necessary.

(Process evaluation)
Residential treatment programs/ housing providers The TDTC has a pilot housing program in place in partnership with the John Howard Society which provides short-term supportive housing to DTC clients.

(Process evaluation)		 About a quarter of DTCRCV participants reside in Recovery Homes for residential treatment for a portion of the program.

DTCRCV staff have also compiled a list of housing providers for participants to refer to for longer-term housing needs.

Since March 2008 DTCRCV has had a housing case manager and has been able to provide subsidies for housing since June 2008. The money that provides this support is due to end in March 2009.		 Many participants receive residential treatment from Poundmaker's Lodge or the Anchorage program.

(Process evaluation)		 WDTC has established a relationship with Manitoba Housing Authority.

(Process evaluation)		 Rideauwood provides a residential treatment program for some participants.

YMCA provides temporary residence for a number of participants who otherwise would be homeless.

(Process evaluation)		 Participants are referred to YWCA, YMCA, Salvation Army, and Welfare Rights for housing.

(Process evaluation)
Graduation requirements Basic requirements for graduation are:
  • abstinence from all substances for a minimum of three months, as verified by random urine screening
  • no new criminal convictions for a minimum of three months prior to graduation
  • having stable housing
  • being employed, or actively involved in volunteer work or employment search, or attending academic upgrading
At graduation, participants receive non-custodial sentences of up to 18 months probation on their initial charges. After probation, they are formally released from the TDTC program.

Participants who make significant positive changes in their lives but do not fulfill all of the graduation criteria may exit the program through the "substantial compliance" exit strategy. These participants are released from the program with a non-custodial sentence and a period of probation.

(Outcome evaluation)		 There are two levels of graduates: honours graduates and graduates. Basic requirements for graduation include:

Honours graduation:
  • abstinence from alcohol and all drugs for three months
  • 265 hours of treatment
  • no criminal offences for six months
  • stable housing
  • engagement in productive activities (e.g., education, employment or volunteer work)
Graduation:
  • abstinence from cocaine, heroine and crystal meth for three months
  • 265 hours of treatment
  • no criminal offences for six months
  • stable housing
  • engagement in productive activities (e.g., education, employment, or volunteer work)
Honours graduates receive suspended sentences and one day of probation. Graduates receive suspended sentences with short periods of probation supervision ranging from one to three months.		 Participants are eligible for graduation after eight months in the program. To attain completion (with honours), participants must have:
  • had no drug use for a minimum of four months
  • substantially completed their I-TRIP
  • contributed to the community through service work
To qualify for substantial completion, participants must have:
  • been clean of all drugs, except cannabis, for four months
  • substantially completed their I-TRIP
  • contributed to the community by undertaking community service work
Track 1 participants have their charges stayed upon completion. Track 2 participants receive a non-custodial sentence commensurate with their original charges.

(Process evaluation)		 Participants are eligible to graduate from the program when they have completed all the requirements for phase 5, meaning they:
  • have attained four months of abstinence from drugs
  • have been involved with the WDTC for 12 to 18 months
  • have made significant progress toward resolving identified issues on their individual treatment plan
  • are working, going to school or involved in significant volunteer work
  • are engaged in a community support Group
  • have not committed any offenses in the last six months (not mentioned in outcome report)
Before graduating, participants must complete an exit interview, and must have a plan for aftercare.

Outcome report does not mention the following: Participants can graduate with honours if they have abstained from all substances, including alcohol and marijuana, for a period of four months.		 There are three levels of graduation from the DTCO:

Level 1:
  • at least 12 months participation
  • abstinence from all substances for at least six consecutive months
Level 2:
  • at least 12 months participation
  • abstinence from all substances for at least three consecutive months
Level 3:
  • at least 16 months participation
Level 1 graduates receive a maximum sentence of one-day probation. Level 2 graduates receive a maximum sentence of 12 months probation.

Outcome evaluation does not mention any of this. It refers only to graduates and successful applicants (successful applicants have received more than 150 days of treatment in the program).		 To graduate from the program, participants must:
  • have 100% clear drug screens for four months
  • have no absences over the last four months
  • have acted on their return to community plan
Outcome evaluation does not discuss graduation criteria. It refers to "graduates" and "completers". There have been 3 and 5 respectively but no definitions are provided to my knowledge.
Target capacity Up to 105 participants have participated in any given year

(Process evaluation)		 100 20 30 35 30
Total participants 365 over four years covered by the evaluation (1999-2003)

67 (April 2007 to September 2008)		 322 admitted from 2001 to 2005 46 from program start to progress evaluation (December 2005 to July 2007)

82 from program start to September 24, 2008 (Outcome evaluation)		 20 during process evaluation (April to June 2007)

78 cumulative (January 2006 to December 2008)		 43 during year one (February 2006 to February 2007)

105 cumulative (since program start; end of evaluation period unknown)		 54 as of January 2008

97 cumulative (October 2006 to September 2008)
Participant characteristics/ demographics (process evaluation) Predominantly male
Average age: 34.2

30% homeless
78% unemployed
77% in custody at application

89% admitted to cocaine program
12% admitted to opiate program		 82% male; 18% female Average age: 31.7

47% Caucasian
17% Aboriginal
36% Asian, Hispanic, Black, and East Indian

Drugs involved in offense
54% Cocaine
28% Marijuana, ecstasy, methamphetamines
11% Cocaine and heroine		 57% female; 43% male

Most (65%) are between 25 and 44. 33% are under 25.

48% Aboriginal/First Nations/Métis
46% Caucasian

39% of females were involved in prostitution.		 50% male; 50% female

54% Aboriginal/Métis; 46% Caucasian

61% used cocaine/crack
27% used crystal meth		 93% Anglophone
7% francophone

Average age: 35.6

26% female; 74% male

83% used crack as drug of choice
7% used heroin
9% used prescription drugs		 35% female; 63% male

Participants range in age from 19 to 53 (28% - 19 to 29; 39% - 30 to 39; 33% - 44 to 53).

68% Aboriginal/Métis
28% Caucasian
Participant characteristics/ demographics (outcome evaluation) Information is available for applicants only:

79% male

Average age: 37 years

66% Caucasian; 19% Black; 15% other visible minorities

Majority of applicants were single		   (Based on 51 former participants):

51% female; 49% male

Most (65%) between 25 and 44. 28% are under 25.

45% Aboriginal/First Nations/Métis
49% Caucasian

63% single		 (Based on 58 former participants):

60% male; 40% female

37.9% Registered Indian Métis;57% Caucasian

36% 18-25 years; 35% 26-36 years; 29% 37 and up

76% cocaine first drug of choice
22% crystal meth first drug of choice

71% used more than one substance		 (Based on 105 admissions since program start):

91% Anglophone
9% francophone

Average age: 35.6 years

23% female ; 77% male

82% used crack regularly		 36% female; 63% male

67% First Nations/ Métis

45% 30-39 years; 31% 18-29 years; 24% 40-53 years

Sources:

TDTC:
Toronto drug treatment court evaluation project final report (Gliksman, Newton-Taylor, Patra, & Rehm, 2004)
DTCV:
Drug treatment court of Vancouver program evaluation: Final evaluation report (Millson, Robinson, Stringer, & Van Dieten, 2005)
EDTCRC:
EDTCRC Process Evaluation Report (Addiction and Mental Health Research Laboratory, 2007).
WDTC:
Winnipeg Drug Treatment Court Interim Evaluation (Gorkoff, Weinrath & Appel, 2007).
DTCO:
Evaluation of the Drug Treatment Court of Ottawa: Year One (Bourgon & Price, 2007).
RDTC:
Regina Drug Treatment Court Implementation & Developmental Evaluation Report (Smithworks Surveysolutions, 2008).