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The Impact of the King County Family Treatment Court on Child and Family Outcomes

Mike Pullmann Eric Bruns Ericka Wiggins University of Washington School of Medicine Division of Public Behavioral Health and Justice Policy www.uwhelpingfamilies.org. The Impact of the King County Family Treatment Court on Child and Family Outcomes. 15th Annual WSADCP Fall Conference

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The Impact of the King County Family Treatment Court on Child and Family Outcomes

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  1. Mike Pullmann Eric Bruns Ericka Wiggins University of Washington School of Medicine Division of Public Behavioral Health and Justice Policy www.uwhelpingfamilies.org The Impact of the King County Family Treatment Court on Child and Family Outcomes 15th Annual WSADCP Fall Conference October 12, 2012 Mark Wirschem Dajani Henderson Sidney Hufstetler King County Family Treatment Court King County Superior Court 1

  2. A child in foster care likely has a parent with a substance problem • 80% of children in foster care have a parent with a substance abuse problem • Parents with substance problems have the lowest rate of reunification with their children • Their children stay in foster care over twice as long on average • Initiation of treatment takes an average of 4-6 months after entry to CW system

  3. Family Treatment Courts are a rapidly prolifierating type of Drug Court • FTDCs apply the drug court approach to cases of child abuse and neglect • Goal = enhance possibility of family reunification within legal timeframes by: • Facilitating entry and completion of treatment • Supporting parent to remain abstinent • Improving child safety/family functioning • As of 2009, NADCP reports 322 FTDCs • 13% of all drug courts in U.S. • Increase of 66% from 2005

  4. 14 counties with FTDCs in Washington * * * * * * * * * * * * * *

  5. Today’s presentation • The King County Family Treatment Court • Goals • Population of focus • Program description • Case flow process • What we have learned from an outcome evaluation

  6. The King County Family Treatment Court Mark Wirschem, Juvenile Court Services Manager Dajani Henderson, FTC Court Specialist

  7. KCTV Video • http://youtu.be/XU1gSDyTBxw

  8. The KCFTC has four Goals: Children have safe and permanent homes within permanency planning guidelines; Families of color have outcomes from dependency cases similar to families not of color; Parents are better able to care for themselves and their children and seek resources to do so; and The cost to society of dependency cases involving substances is reduced. 8

  9. The King County Family Treatment Court • 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 9

  10. Population Focus Up to 60 children at a time, whose parent(s): • Admit to the court that his/her child is dependent or have an existing dependency finding • Are chemically dependent and willing to go to treatment; • Are at least 18 years of age; • Sign a Consent to Release Confidential Information Form so that the team may share information with other team members and outside community providers; • Have no felony child abuse or sexual abuse guilty findings; and • Applications/referrals to FTC must be received no later than six months from the date of dependency petition.

  11. KCFTC Program Model • Parents agree to enter a more intensive court process • Expectation = 12 mos – 2 years duration • Case management to ensure connection to appropriate chemical dependency treatment • Social Workers dedicated to the FTC with reduced caseloads (12:1) and a Court-Appointed Special Advocate is dedicated to each KCFTC family • Formal Wraparound Process for approx 1/3 of families (15 at a time) • Treatment Liaison who monitors parent’s progress in CD and MH treatment and provides case management • Case review hearings every other week until frequency can be stepped down • Cross-disciplinary pre-hearing staffings to present a unified approach at hearings

  12. Judge Assistant Attorney General Parent’s Defense Attorney Child’s Attorney Treatment Specialist Treatment provider Court Appointed Special Advocate (CASA) Wraparound coordinator DCFS Social Workers FTC Program Supervisor FTC Program Court Specialist Family members/friends Family support providers KCFTC Team Members

  13. Petition Exit System Dismissed Petition Petition Petition Petition Petition Dismissed Dismissed Dismissed Dismissed Dismissed Enter FTC* (See separate flow chart) Shelter Care 30 - Day Shelter Pre - Trial Fact - Finding Disposition Shelter Care Hearing Placement in Dependency Case Conf . Care Review Conference Hearing Petition Hearing ( w / in 72 hours of place - Shelter Care Petition Filed Approved ( w / in 30 days of ment or filing , whichever ( 30 days prior to ( 21 days prior to ( w / in 75 days ( same day as or w / in 14 occurs first ) placement ) fact - finding ) of filing ) days of dep finding ) fact - finding ) Dependency Stipulated Dept . Review Hearing Child supervision ( the sooner of 90 days returned continues for from Dispo . or 6 mos . Exit FTC w/o Permanency Goal Achieved home from date of placement ) 6 mos . Dependency Continued Review *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. Permanency Hearing Planning Hearing ( 12 months from date of placement & every 12 months thereafter ) Permanency Yes Goal Achieved ? No Petition for Yes Parental Rights Termination ? No Review Hearing ( w / in 6 months after permanency planning hearing ) Petition for Petition for Termination of Permanency Yes Parental Rights No Yes Parental Rights Goal Achieved ? Termination ? Filed Original Chart prepared by Michael Curtis on January 12, 2006 No Juvenile Dependency Case Flow (noting FTC) 13

  14. Other FTC Hearings: 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 duringregular FTC calendar 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 Discharge/Opt Out Hearing: Dependency dismissed or discharged to regulardependency FAMILY TREATMENT COURT CASE PROCESSING FLOW CHART 14

  15. Sidney Hufstetler King County Family Treatment Court Graduate

  16. Evaluation of the King County Family Treatment Court Division of Public Behavioral Health and Justice Policy University of Washington School of Medicine UWHelpingFamilies.org

  17. Goals for the Current Evaluation • Provide information needed by the KCFTC and its stakeholders • Expand the research base on FTDCs • Do FTDCs achieve their stated goals and outcomes? • Do they contribute positively to federal priorities for CW systems? • Do common criticisms of drug courts apply to FTDCs? • Widening the net of involvement in justice system • Mandate longer involvement in justice system • Limit access to or completion of treatments • Not cost effective

  18. 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 18

  19. Outcome Evaluation:Research Question 1 • When compared to comparable non-FTDC participants, do FTDC participants differ in terms of their experience with the court and treatment system? • Hypotheses – FTDC participants would: • Have more court hearings; • Enter treatment more often; • Enter treatment more quickly; • Attend treatment sessions more consistently; • Receive more treatment events; • Receive a broader treatment array; • Remain in treatment longer; and • Successfully discharge from treatment more often.

  20. Research Question 2 • When compared to children of non-FTDC participants, do children of FTDC participants demonstrate more positive child welfare outcomes? • Hypotheses – KCFTC children would: • Spend less time in out-of-home placements; • Reunify with their parents more often; • Get placed in permanent living situations more quickly; and • Have fewer subsequent child welfare investigations and founded investigations

  21. Research Question 3 • Do families of color have outcomes similar to families not of color? • Treatment outcomes • Child welfare outcomes

  22. Outcome Evaluation • Administrative data: • Treatment data from Division of Behavioral Health and Recovery • Child welfare data from Children’s Administration • Hearing data from King County Superior Court • 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 (propensity score methods) on caregiver age and race, number of prior child welfare investigations, whether parent was in treatment at petition, number of prior treatment episodes, and primary drug of choice

  23. Reasons why parent is in comparison group

  24. Detail: specific race/ethnicity Parent demographics • Mean # of children per participant • Comparison=1.39 • KCFTC = 1.46 • Parent mean age • Comparison = 31 • KCFTC = 31 • Total # of parents = 268 • Comparison = 182 • KCFTC = 76 Note: no significant differences

  25. Prior Investigations Note: No statistically significant differences

  26. Child demographics • Child Mean Age • Comparison = 4.2 • KCFTC = 3.5 • Number of children • Comparison = 235 • KCFTC = 89 Note: Statistically significant difference for Native American

  27. Status of FTC parent at time of data collection 27

  28. 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

  29. Question 1: Do FTC participants have different treatment and court experiences than comparable non-FTC parents? • Do they experience more court hearings? • 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?

  30. FTC parents have more court hearings • 11 months post petition (min follow up time for overall sample): • FTC: mean 16.1 (SD = 4.8) hearings • Comp: 5.9 (2.4) • (p<.001) • Review hearings were 4.5 times more frequent for FTC (accounted for 75% of all FTC hearings)

  31. FTC parents are more likely to enter treatment FTC parents were 63% more likely to be admitted to treatment. Note: All differences statistically significant

  32. FTC parents enter treatment three times as fast • Of those parents entering treatment who were not already in treatment at the index petition, the median days until treatment entry were: • Comparison: 120 • KCFTC: 36 Proportion not admitted Note: Statistically significant difference, p < .001

  33. FTC parents received broader service array Of those admitted to any treatment * Statistically significant difference, p < .05

  34. FTC parents received broader service array Of those who received any treatment * Statistically significant difference, p < .05

  35. FTC parents received more treatment but were not significantly more likely to attend treatment • Avg. # of treatment events per person who received treatment: • KCFTC = 116 (SD=97) • Comparison = 51 (SD=57) Note: Statistically significant difference, p < .05 Note: Not statistically significant difference, p =.40

  36. FTC parents remain in treatment longer (Of those entering treatment; N=110) • Of those parents who entered treatment, the median days in treatment were: • Comparison: 44 • FTC: 109 Note: Statistically significant difference at beginning and middle, p < .05

  37. FTC parents more likely to be successful in treatment • FTC parents remained in treatment twice as long (median of 109 days compared to 44) • FTC parents 37% more likely to be successfully discharged from treatment (72% compared to 54%) Note: Statistically significant differences, p < .05

  38. 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 investigations?

  39. FTC children spend less time in out-of-home placements • Median days in out of home placement: • Comparison: 689 • FTC: 476 Note: Statistically significant difference, p < .05

  40. FTC children end involvement with the child welfare system more quickly • Median days until permanent placement: • Comparison: 813 • FTC: 718 Note: Statistically significant difference, p < .05

  41. Child Welfare OutcomesAt end of study window • FTC children spent 30% less time in out-of-home placements • median of 476 days, compared to 689 • FTC children spent 20% less time in the child welfare system • median of 718 days, compared to 813 • FTC children 43% more likely to have a permanent placement • 61% compared to 43% Note: Statistically significant differences, p < .05

  42. Placement types/ReunificationAt end of study window • FTC children 2.5 times more likely to return to the custody of their parent (27% compared to 11%) • FTC children half as likely to be in an out of home placement (24% compared to 46%) • FTC children 1.9 times more likely to be returned home (in parental custody, reunified, trial home visit; 55% compared to 29%) Note: Statistically significant differences, p < .05

  43. Subsequent child welfare investigations: All parentsAt end of study window Note: Not statistically significant difference

  44. Subsequent child welfare investigations: Only parents with child returned home At end of study window p=.09 p=.13

  45. Subsequent child welfare investigations: All childrenAt end of study window Note: Not statistically significant difference

  46. Subsequent child welfare investigations: Only children who returned home At end of study window Subsequent removals: 3% for FTC group (n=1) vs. 13% for Comparison (n=3); p=.13

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

  48. 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

  49. 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)

  50. Outcome Study Summary • 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 • Other research with similar findings to our research also found significant long-term cost savings

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