Drug Treatment Court Funding Program, Summative Evaluation

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5. Conclusions And Recommendations

This final section of the report summarizes the evaluation findings according to the four main evaluation issues: relevance; design and implementation; outcomes; and cost effectiveness/ alternatives.

5.1. Relevance

DTCs respond to long-standing government priorities to address substance use and abuse issues in a criminal justice context. Recognizing the link between drug use and crime, the government created the DTCFP to expand the number of DTCs in Canada as part of the renewed Canadian Drug Strategy and has since reiterated this commitment under the National Anti-Drug Strategy.

The belief in these specialized courts as an innovative method to address non-violent, drug-motivated crime finds support in the literature. Studies in the United States and Canada demonstrate the relationship between drug use and crime and support the position that the specialized courts lower recidivism. Through interviews and surveys, the evaluation found strong support for the DTC model among criminal justice professionals, addictions specialists, and community or government organizations that have been involved with the DTCs. Based on their experiences with DTCs and the traditional criminal justice system, they believe that specialized drug courts work. By combining judicial supervision with substance abuse treatment, DTCs provide an effective alternative to the traditional criminal justice system.

The DTCFP remains relevant because without it, some DTCs would likely close, particularly those managed by NGOs, as the funding stream is already an issue at several of these locations. In addition, the creation of new DTCs would be less likely. This would place Canada solidly against the international trend, which is the expansion of DTCs.

5.2. Program Design and Implementation

5.2.1. DTCFP

The evaluation found that the DTCFP has met its essential mandate, which was to oversee the expansion of DTCs. Since its creation, the DTCFP has approved four new sites and continued the funding of two existing sites. Its flexible management style that included more intensive consultation with the sites during their initial stages and allowed them to develop their own models of service delivery was appreciated by the sites. The DTCFP has responded to challenges in managing the contribution agreements. The original expectation of provincial applicants proved to be incorrect, and with NGOs as funding recipients in four of the six sites, the DTCFP has changed the terms and conditions of the contribution program and provided regular advances to some sites.

The DTCFP has also supported communication activities with varying success. The CADTC meetings/conferences received praise from those in attendance as effective ways to network and share best practices. There was little awareness/use of the Department research reports on DTCs and the electronic bulletin board. The evaluation found support for more opportunities for DTC team members to ask questions and share information. In addition, results indicated a need for more promotional/informational efforts to ensure that key stakeholder groups such as police and defence counsel are aware of and understand the DTC program.

The most challenging area for the DTCFP was collecting information and data on the effectiveness of the DTCs. It was found that the current systems and processes in place to collect information on the effectiveness of DTCs require improvement. Data are not consistently and reliably kept, and the methods of reporting outcomes do not result in comparable information. Although substantial work had been undertaken (construction of the DTCIS and evaluations of the sites), quantitative evidence of the outcomes for the program, such as its effect on recidivism and drug use and its cost effectiveness, was preliminary, not comparable across sites, or not available. These difficulties are not surprising. Many of the DTCs are relatively new, which limits the ability to demonstrate effects as post-program follow-up periods are short (see Latimer, Morton-Bourgon, and Chretien, 2006 on the importance of sufficient time for follow-up). In addition, few sites were able to conduct rigorous evaluations with comparison groups and, even if they could, the fact that more recent DTCs have relatively few graduates makes these kinds of costly studies premature. The DTCIS should provide future studies of the DTCs with comparable data; however, it remains a work-in-progress, and even with planned revisions will not capture post-program recidivism and other information that would assist in measuring key program outcomes.

It was also difficult to make comparisons between DTCs as the data were collected and reported on differently. To enable comparisons across DTCs, the DTCFP should work with DTCs to develop a few well-defined core performance measures to be systematically collected and reported on in the DTC site evaluation. In addition, the DTCFP may want to consider an alternate evaluation model to allow for a more coordinated approach to evaluation activities. Should the site-level evaluations continue, the sites should be required to operate from a shared evaluation framework that includes the reporting on the core performance measures.

5.2.2. DTCs

DTCs are intended to address the criminal behaviour of high needs individuals who have engaged in non-violent offences that were motivated by their addictions. The evaluation found that the DTCs are meeting this goal as the participants have a lower socio-economic profile and multiple needs such as physical health and mental health concerns, and lack of adequate housing. Participants also have serious drug addictions (typically cocaine) and have committed a variety of non-violent crimes.

However, the program is having more difficulty attracting individuals from the DTCFP's target groups of youth (operationalized as 18 to 24 year olds), Aboriginal men and women, sex trade workers as well as women in general. Suggestions to address this issue include having specialized programming for youth, Aboriginal people and women, which could be separate groups and/or more tailored content; separate days in court for men and women; and more Aboriginal workers or connections with Aboriginal community organizations. While many DTCs want to provide specialized programming, they struggle with being able to provide this type of support due to limited staff.

For the DTCs, the program has high-level similarities across the courts but also key differences. This is to be expected when each site designs its own program and supporting processes and structures. Over time, it would be useful to study the different approaches across key indicators like recidivism and drug use so that evidence-based practices can be identified and shared across the sites.

The evaluation found that the court component is working effectively based on the information available. Court attendance assists clients by providing a routine and motivating them through the use of rewards and sanctions. More rewards than sanctions are provided by the courts. The evaluation cannot offer quantitative data on the effectiveness of rewards or sanctions; however, interviews with participants and DTC staff indicate that these methods of encouragement work.

Likewise, the evaluation found that the treatment component is generally working effectively based on the information available. Based on qualitative information, participants appreciate the non-judgmental approach of treatment staff and their helpfulness in connecting participants to other available resources. Treatment was considered to be suitably intense, although there was evidence that more tailored programming or approaches would be useful, particularly to address race and gender needs, but also to be more flexible and less stringent in order to meet the needs of low-risk participants who are doing well in the program. Because the treatment delivery models differ across the sites, it would be useful to be able to compare the results for participants by the different approaches, which can be accomplished once comparable data are collected.

The DTCs identified several challenges for implementation that were shared across sites. Most of the sites had either currently, or in the past, experienced challenges with understanding the roles and responsibilities across the treatment and court teams. The challenge for these multidisciplinary teams is developing working relationships that recognize the role of each member and do not compromise the integrity of the program.

Another major challenge is a lack of safe housing and treatment beds, which limits the DTCs' ability to accept participants and/or stabilize those in the program. DTC team members reported poor success with participants who remain in high-risk environments like shelters. While more work needs to be done, the DTCFP recognized this challenge and sought a partnership with HRSDC to identify funding opportunities associated with the Homelessness Partnership Strategy.

Finally, resource constraints (financial and human) are reported to limit what the DTCs can accomplish. Caseloads are considered too heavy to provide intensive, individualized treatment, and lack of staff limits the types of programming that can be provided. Additional resources would also assist sites in subsidizing housing and providing participants with other essential needs (food, clothing, medical/dental care) that helps stabilize them and enables them to focus on addressing their addictions.

5.3 Outcomes

Two considerations should be kept in mind in considering the outcomes of the DTCFP. First, the program targets marginalized and high-risk groups with multiple barriers to success, such as serious addictions, extensive criminal backgrounds, lack of education, poor employment history, mental health or other health issues, and past victimization. Second, most of the DTCs have been operational for a short period of time, and those that have a longer history (Toronto or Vancouver) have not been engaged in ongoing performance measurement tracking. This limits the ability to report on results.

However, based on the information available, the findings of this evaluation as well as the five site evaluations suggest that the DTCFP is generating positive outcomes for participants.

Recidivism.

Most key informants, survey respondents and case study participants believe the program is reducing recidivism. Some of the DTC outcome evaluations reported on recidivism. Winnipeg found that recidivism rates for graduates compared favourably to rates for probation, conditional sentences and provincial inmates. Discharged participants also had lower recidivism rates than the other offender groups except for probation. However, the Winnipeg results fall well outside the meta-analyses on the effects that DTCs have on recidivism. As noted by the site evaluation, the Winnipeg results are preliminary. Ottawa found that reoffending was more common in the first year of the program than in subsequent years.

Drug use.

The evaluation found that the DTCFP has had an impact upon participants drug use. However, it also noted that participants' volume, frequency and type of use may change for the better or worse several times throughout the program. Nonetheless, many of the case study participants indicated that the program has helped them abstain from drug use, even if they have an occasional relapse. Case study participants said that personal motivation is one of the key factors that determine whether someone will be successful in the program. However, several program features also help set participants up for success including the recognition that relapse is part of the recovery process, the length of the program, the court sessions, the support of the treatment staff and the counseling sessions, and access to safe, drug-free housing.

Enhancing social stability.

The DTCFP is helping participants enhance their social stability. Many participants have improved their housing, gained employment, and/or returned to school. Other participants have improved their relationships with their family, feel healthy, and care about themselves.

Graduation and retention rates.

The evaluation was able to calculate comparable graduation and retention rates across the DTCs. The graduation rates ranged from 6 percent to 36 percent and the retention rates ranged from 34 percent to 55 percent. In interviews and the site evaluations, the factors that influence participant retention and graduation include safe, secure housing; self-motivation; low-risk background (no criminal history or history of violence); and various demographic factors (race, education level, employment at admission, marital status, and gender).

5.4. Cost Effectiveness/Alternatives

The evaluation made a preliminary attempt at assessing the relative cost advantages of DTCs. Due to the limited availability of consistent and complete outcome data and cost information, the analysis requires making several assumptions about DTCs and the traditional system. The potential for DTCs to generate cost savings for government and society varies with the type and length of sentence that would have been applied through the justice system. Assuming a DTC participant graduates from the program and does not reoffend, the costs of the DTC are 70 percent lower compared to two years of incarceration. However, if an offender is sentenced to one year of probation, the cost of DTC is 365 percent higher than the conventional system. Although this analysis shows the potential for cost savings, more thorough analysis requires additional information on DTC and corrections costs for individual sites/provinces, long-term outcomes such as recidivism, and other costs such as overheads, social assistance, and estimates of improvements to quality of life.

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