Drug Treatment Court Funding Program Evaluation

4. Key Findings

This section combines information from all lines of evidence and presents the findings according to the broad evaluation issues of relevance and performance.

4.1. Relevance

This section reports on the relevance of the DTCFP. It discusses the alignment of the DTCFP with federal priorities and the continued need for the program.

4.1.1. Alignment with Federal and Departmental Priorities

The DTCFP aligns with federal priorities as evidenced by long-standing federal commitments to address crime and drug use in Canada. Since their inception, DTCs have been part of the federal anti-drug strategy and criminal justice agenda. The Toronto and Vancouver DTCs were initially introduced as part of Phase II of Canada’s Drug Strategy (CDS) launched in 1992, with funding from the Crime Prevention Investment Fund (CPIF) of the National Crime Prevention Strategy.

In 2007, when the National Anti-Drug Strategy was announced, the federal government renewed its commitment to programs combining treatment and enforcement, such as the DTCs and the DTCFP (Government of Canada, 2007). The Strategy’s goal is to “contribute to safer and healthier communities through coordinated efforts to prevent use, treat dependency and reduce production and distribution of illicit drugs”. The prevention, treatment and enforcement action plans guide these efforts. The DTCFP is funded under the Treatment Action Plan, the objective of which is to “support effective treatment and rehabilitation systems and services by developing and implementing innovative and collaborative approaches” (Government of Canada, 2014).

Throne Speeches and federal budgets, as well as legislative changes since 2009 provide evidence of alignment between DTCs and the federal government’s crime agenda and drug-related priorities. In the 2010 Speech from the Throne, the federal government reiterated its concern with drug crimes, making a commitment to “reintroduce tough legislation to combat the organized criminal drug trade” (Government of Canada, 2010). Similarly, the 2011 Speech from the Throne referred to the reintroduction of “comprehensive law-and-order legislation to combat crime and terrorism” (Government of Canada, 2011). In the following year, the federal government tabled and Parliament passed the Safe Streets and Communities Act. This act was intended to support the National Anti-Drug Strategy by creating mandatory minimum penalties for serious drug offences (Department of Justice Canada, 2012). The legislation, while expressly intended to “hold offenders accountable for their actions”, recognized the role of DTCs in addressing drug-related crimes. It included Section 720(2) of the Criminal Code and sections 10(4) and 10(5) of the Controlled Drugs and Substances Act (CDSA) (which came into force on November 6, 2012). These sections allow courts to delay sentencing of drug-addicted offenders while they attend provincially approved and court-supervised treatment programs — including DTCs.

The DTCFP also supports the Department of Justice’s first strategic outcome, which is “a fair, relevant, and accessible justice system”. As stated in the most recent Report on Plans and Priorities, the Department of Justice uses contribution and grant funding, such as the DTCFP, to facilitate access to justice and support the functioning of the Canadian criminal justice system (Department of Justice Canada, 2014).

4.1.2. Alignment with Federal Roles and Responsibilities

Canada’s first federal drug strategy was introduced in 1987 under the title “National Drug Strategy”. It acknowledged that substance abuse was primarily a health issue but continued the enforcement-based approach that Canada has adopted since enacting the Opium Act in 1908, which made it illegal to import, manufacture or sell opium. Efforts to control and regulate psychoactive substances have subsequently relied on legislation to ban the production, distribution and use of illicit drugs. The legislation used has included the Opium and Drug Act, the Narcotic Control Act, the Food and Drug Act and the current CDSA. In 1988, Parliament created the Canadian Centre on Substance Abuse as Canada’s national NGO on addictions. Its primary responsibility is to provide objective information on addiction. Canada’s Drug Strategy was renewed in 2003, and in 2007 the Government of Canada introduced its National Anti-Drug Strategy (NADS). The goal of the current NADS is to contribute to safer and healthier communities through coordinated efforts to prevent use, treat dependency, and reduce production and distribution of illicit drugs. The DTCFP is funded under the NADS treatment action plan.

Funding of the DTCs through the DTCFP aligns with the constitutional division of authorities related to criminal justice. Under the Constitution Act, criminal justice is an area of shared responsibility between the federal/provincial/territorial (F/P/T) governments. The federal government has authority for criminal law-making, criminal procedure and penitentiaries, and the provinces and territories are responsible for the administration of justice and reformatories. By using the policy lever of the DTCFP, the federal government respects the constitutional division of authority and helps fund the DTCs without becoming directly involved in their administration.

Under section 10(4) (a) of the CDSA, a DTC program must be approved by the Attorney General. In order to be approved by the Attorney General, the program must comply with the internationally recognized DTC principles Footnote 4. The Chief Federal Prosecutor in the appropriate province, territory or region can approve the DTC program in that area on behalf of the Attorney General.

The new sections 10(4) and 10(5) of the CDSA, which came into force on November 6, 2012, allow a court to delay sentencing while an addicted offender either participates in a DTC program approved by the Attorney General, or attends a treatment program approved by the province under the supervision of the court as outlined in section 720(2) of the Criminal Code. If the person successfully completes the treatment program, the court is not required to impose the mandatory minimum penalty for the offence.

4.1.3. Continued Need for the DTCFP

With DTCs internationally now into their third decade of operations, an expansive literature exists that considers the issues the DTCs address and their effectiveness. Based on this literature and survey results, the evaluation findings demonstrate that there remains a continued need for DTCs and the DTCFP.

Relationship between addictions and crime

Research studies from many countries have found a strong association between criminal behaviour and the use and abuse of drugs and alcohol (Pernanen et al., 2002; Koehler et al., 2013). Various studies, systematic reviews, and meta-analyses have established that a) those with substance abuse issues are more likely to have committed crimes, and b) those who have had contact with the criminal justice system are more likely to have substance abuse issues (Koehler et al., 2013). While the strength of this association is somewhat in dispute, studies have produced relatively high estimates of the share of crimes that can be attributed to the use and abuse of drugs and alcohol, and of the prevalence of addiction issues in prison populations. For example, in Canada, a series of studies undertaken by the Canadian Centre on Substance Abuse found that over half of federal and provincial inmates reported using drugs prior to their arrest and being under the influence of a psychoactive substance when they committed their most serious crime (Pernanen et al., 2002). A systematic review of studies Footnote 5 on the prevalence of substance abuse and the dependence of prisoners upon their entry into custody, found that estimates for the prevalence for drug abuse and dependence ranged from 10-48% in male prisoners and 30-60% in female prisoners (Fazel, Bains, & Doll, 2006).

In addition to highlighting the association between criminal behaviour and drug use, evidence indicates that much drug-related crimes are committed for the purposes of satisfying an addiction. According to Pernanen et al., “a significant proportion of crimes are reported to have been committed in order to obtain psychoactive substances for personal use” (2002, p. 8). Survey respondents also highlighted that DTC target populations have engaged in criminal activity due to their complex/lengthy addictions.

Studies have also estimated high costs associated with illicit drug use that are borne by society as well as the justice system. For example, Rehm et al. (2006) estimated the social cost of illegal drug used to be $8.2 billion for one year in Canada. This estimation includes both direct costs (i.e., the burden on health care, law enforcement and other services) and indirect costs (i.e., loss of productivity resulting from premature death, disability or ill health). In 2008, a Department of Justice report calculated that $1,294,330,000 was needed to cover just the direct health care costs associated with illicit drug use in the previous year (Zhang, 2008). When updated to 2012 prices, the estimate rises to $1,380,000,000 (Easton, Furness, & Brantingham, 2014). While researchers have noted variations and uncertainties in assessing the costs of drug use and drug-related crime Footnote 6, they point out that, given data limitations, estimates of the association between illicit drug use and crime and the costs of drug-related crime use can be conservative (Pernanen et al., 2002; Zhang, 2008).

Drug-related criminal behaviour appears to be an ongoing (and potentially increasing) problem, as data on police-reported drug offences in Canada show an increase in the rate of drug offences over time. For example, a 2009 Statistics Canada report indicated that drug offences had been generally increasing in Canada since 1993 (Dauvergne, 2009). According to more recent data, although the overall crime rate in Canada decreased by 28.1% between 1998 and 2012, the crime rate for drug offences increased 33.4% over the same period — from 235 per 100,000 population in 1998 to 314 per 100,000 population in 2012 (Public Safety Canada, 2013). Footnote 7

Support for the DTC model

Given the strong links between drug use and crime and the high costs of criminal behaviour linked to substance abuse, it follows that effective interventions to address drug-related crime and reduce recidivism in this area are needed. Drug courts are one intervention option. They are a therapeutic intervention that provides court-supervised treatment as an alternative to the criminal justice system, which emphasizes incarceration, probation, and parole, often without provisions for accompanying treatment (UNODC, 2010).

This evaluation found evidence of support for both the philosophy behind drug courts and the relevance of the drug court model. With regard to philosophy, arguments have been made by researchers in favor oftreating drug-addicted offenders. Footnote 8 As neurobiological research has determined that addiction is a treatable brain disorder, some researchers have argued that treating offenders can be successful and can result in significant improvements to both public health and safety (Chandler, Fletcher, & Volkow, 2009). Given that drug-addicted offenders are unlikely to seek treatment on their own, “the criminal justice system provides a unique opportunity to intervene and disrupt the cycle of drug use and crime in a cost-effective manner” (Chandler, Fletcher, & Volkow, 2009, p. 189). In addition, literature points out that drug-using offenders often have many co-occurring issues (e.g., poverty, mental and physical health issues) and significant treatment needs in multiple areas Footnote 9; some studies also indicate that incarceration does not adequately address (and can, in fact, exacerbate) these co-existing problems (Aos, Miller, & Drake, 2006; Chandler, Fletcher, & Volkow, 2009). Survey respondents strongly believed that DTCs are better equipped to meet the needs of the DTC target populations than the traditional justice system. Some 82% of respondents believe that the DTCs are somewhat or very effective in addressing participants’ needs, compared to 17% of respondents who believe the traditional justice system is somewhat or very effective in meeting the needs of the DTC target populations.

In terms of the relevance of the DTC model, studies of specialized drug courts and drug treatment programs provide evidence of promising results. Studies of various types of adult corrections programs aimed at drug-addicted offenders have found that drug courts consistently achieve reductions in recidivism (Aos et al., 2006; Downey & Roman, 2010; Leticia Gutierrez & Bourgon, 2009; Koehler et al., 2013; Latimer, Morton-Bourgon, & Chrétien, 2006; Mitchell, Wilson, Eggers, & MacKenzie, 2012; Mitchell, Wilson, & MacKenzie, 2006; Shaffer, 2006, 2011) Footnote 10 Footnote 11 Footnote 12. From the results of their meta-analysis, Downey and Roman concluded that “it is virtually certain that the average drug court effect is a reduction in recidivism”. They found this to be true for all studies, regardless of level of rigor (2010, p. 35). Some studies have also found that the effects of drug courts on recidivism rates last for years after program completion (Mitchell et al., 2012) Footnote 13.

Importance of federal involvement

Evidence indicates that federal contributions in support of DTCs in Canada continue to be appropriate and are important to their continuation. Among stakeholders, the DTCFP is considered vital to the continuation of the DTCs. Four-fifths (80%) of survey respondents believe that there is an ongoing need for the DTCFP, and 44 of 65 survey respondents provided specific examples of the importance of DTCFP funding and support to DTCs. Specifically, these survey respondents noted that loss of DTCFP funding could result in: closure or reduction of services of existing DTCs; a negative effect on the consistency of DTCs; detrimental effects on DTC participants; and negative impacts on the justice system. Some respondents commented that the provincial governments may not address any funding shortfall should federal funding be reduced Footnote 14.

Literature also provides some support for the use of federal funding to sustain the operation of DTCs. A 2011 meta-analysis of 198 evaluations of DTCs in the United States found that DTC programs implemented with federal funds were more effective than other DTC programs. The researchers attributed this finding to the guidelines and regulations implicit in the receipt of federal funds (Shaffer, 2011).

The federal government is continuing to work collaboratively with provinces and territories on DTCs. The amendments to sections 10(4) and 10(5) of the CDSA prompted consideration of the federal role in overseeing and sustaining DTCs. In response to these amendments, the Ad Hoc Federal/Provincial/Territorial (F/P/T) Working Group on DTC Efficiencies and Resource Allocations was developed. In addition to defining the key characteristics required for an effective and efficient DTC model, the mandate of this working group involves discussing appropriate F/P/T oversight of federally funded DTCs. This ongoing work reflects the commitment to the continued need for DTCs and the DTCFP.

4.2. Design and Implementation

This section considers the effectiveness of the design and implementation of the DTCs as well as the management of the DTCFP.

In considering the design and implementation of the DTCs, each subsection incorporates a discussion of best practices for DTCs derived from the literature, particularly those identified in the Adult Drug Court Best Practice Standards (Volume 1) developed by the National Association of Drug Court Professionals (NADCP). These peer-reviewed best practices, developed by a diverse and multidisciplinary committee of drug court practitioners, subject matter experts, researchers and government policy-makers, encompass DTC practices that have been shown by reliable evidence to significantly improve outcomes (NADCP, 2013). Where relevant, “key components” of drug courts identified by the United States Bureau of Justice Assistance (BJA, 2004) will also be referenced. Footnote 15

Although the best practices and principles listed in these resources are aspirational and not obligatory, and do not represent a complete list of all useful DTC practices, they provide an evidence-based and useful point of comparison for considering the design and implementation of the DTCFP-funded DTCs.

4.2.1. Organizational Structure and Governance

This section considers organizational structure and governance both in terms of the DTCs funded by the DTCFP, as well as the funding program itself.

DTC team composition and decision-making practices

Best practice sources highlight the importance of the multidisciplinary organization and collaborative nature of the DTC model. As judges do not have training in clinical treatment, collaboration between a DTC’s court and treatment components results in an effective and appropriate court response to participants’ behaviour (NADCP, 2013). While judges must make the final decision on the use of incentives or sanctions, this decision should take into consideration the input of the DTC team. In particular, when imposing treatment-related conditions, the judge should rely on the expert input of trained treatment professionals (NADCP, 2013, pp. 21, 23, 24). To facilitate this collaboration, DTCs should have structures and practices in place to ensure regular, timely communication among DTC team members, including between the court and treatment teams (BJA, 2004, p. 4).

Evaluation evidence indicates that the DTCFP-funded DTCs adhere to many of the best practices and key components identified above — particularly with regard to the multidisciplinary nature of DTC teams, the interaction among all team members, and the process for ensuring that judges make informed decisions. All DTCs include diverse teams that share information and interact on a regular basis. Although the precise membership of DTC teams varies, they are all multidisciplinary and, at a minimum, include judges, Crown counsel, treatment professionals and defence counsel. Some sites include probation officers in the team, but the alignment of the probation officers varies; in some courts, probation officers are more closely aligned with judge and Crown, and in other courts, with the treatment team.

In accordance with best practices, all DTCs have regular meetings and structures in place to ensure ongoing interaction among the DTC team. Meetings include case management sessions among the treatment team and pre-court meetings that bring together representatives of the treatment and court teams to report on participants’ progress to the DTC judge. Survey results indicate general confidence with the structure and administration of the DTCs. This is particularly the case with respect to collaboration within the DTC teams — further verifying DTC adherence to best practices in this area. The majority of survey respondents agreed that there is strong collaboration among the court team (75%), among the treatment team (71%), and between the court team and treatment team (69%).

Roles and responsibilities of DTC team members

As noted above, each DTC has its own team composition, which is a standard practice for DTCs internationally. With no one model, the best practice for DTCs is clarity among the team of each member’s roles and responsibilities. The one team member who has had more detailed best practices developed is the DTC judge, since every DTC has a judge. As is discussed below, the evaluation findings indicate that the DTCs are following best practices, although clarity of team members’ roles could be improved, as could some aspects of the judge’s role in some DTCs.

For all DTCs, the role of the judge follows best practices in terms of his active involvement in the treatment process, and his practice of consulting with treatment professionals prior to making decisions concerning DTC participants (BJA, 2004; NADCP, 2013). As the judge attends the pre-court sessions and court meetings at all DTCs, he is involved in the treatment process. During pre-court meetings, typically, the treatment team shares information on each participant’s progress in treatment, and the Crown and defence counsel provide information on legal issues affecting the client (such as absence from program without official leave or missing curfew). Discussions then occur among the team about the issues presented on each participant, with recommendations made to the court on sanctions or rewards. The team may also make recommendations related to graduation or expulsion from the DTC. Even though the final determination resides with the judge, all DTCs include this mechanism whereby the treatment team can make recommendations and give opinions regarding the court response.

Some DTCs do not conform to the best practice whereby participants mostly appear before the same judge during their time in the program (NADCP, 2013, p. 20). Some DTCs have more than one judge and those judges often sit on a rotating basis. There is no evidence from this evaluation to suggest that the lack of continuity in judges is having a negative impact on DTC participants; case study participants, regardless of DTC, expressed general satisfaction with the judges. Footnote 16 Nevertheless, given that continuity in judges has been shown to have a positive effect on participants’ outcomes (NADCP, 2013), this could be an area of further study in terms of its feasibility.

Going beyond the role of judges, evaluation findings indicate room for improvement with regard to clarifying the roles and responsibilities of other DTC team members. Although survey respondents were generally positive about all aspects of the structure and administration of DTCs, survey results indicate that stakeholder perceptions regarding clarity of roles and responsibilities are somewhat lower than perceptions about other aspects of DTC administration. Whereas two-thirds of respondents strongly agreed that strong collaboration occurs among DTC team members, less than half strongly agreed that the roles and responsibilities of each DTC stakeholder group are sufficiently clear. Similarly, when asked to provide some specific advice to improve the DTC structure and administration, survey respondents most often mentioned the need to clarify roles and responsibilities (14%), improve decision making (8%), address staff turnover/lack of stability (8%), and provide more standardization or consistency in overall approach (6%) Footnote 17.

Although recognizing the importance of maintaining flexibility and allowing variation in DTC structure (so that some DTCs are able to work well within the local context), during the site visits for the case studies, some DTCs raised questions about what should be the appropriate roles for team members. In particular, the DTCs have very different approaches as to who conducts UDT tests. In some locations, counsellors perform the tests, while in others either case managers or health professionals who are not involved in treatment conduct the tests. Some DTC team members raised questions about the appropriateness of counsellors conducting UDTs (which may undermine participants’ level of comfort and openness with their counsellors). These team members indicated that some general guidelines with regard to appropriate job descriptions for DTC team members would be helpful.

Some DTCs are addressing the need for greater clarity concerning roles and responsibilities through updating or developing policy and procedure manuals and/or conducting strategy sessions among the team. Survey respondents considered the need for policies and procedures or some other written documentation that sets out roles and responsibilities particularly important because of the rather high staff turnover in some DTCs. Footnote 18 Other specific suggestions made by survey respondents for clarifying roles and responsibilities included increasing collaboration and transparency in Crown decision making regarding applicants; and examining roles of DTC committees to ensure lack of duplication in discussion of issues.

DTCFP – Management/administration considerations and structural guidance

DTCFP federal program officials report that the DTCFP was able to undertake all planned activities during the evaluation period (2009–14) with federal funding provided through the program. One of its principal goals — in response to recommendations from the 2009 evaluation of the DTCFP — was to build stronger relationships with provincial and territorial governments. Given that the administration of justice is a provincial responsibility, it is important to consider the role of provincial and territorial governments in administration of the DTCFP. Developing effective partnerships with provincial governments in the administration of DTCs has the added benefit of facilitating more effective leveraging of, and greater collaboration with, various provincial ministries. (This is the case in Vancouver, where the provincial government has been the funding recipient since its inception; the provincial government takes the lead on involving other provincial ministries.)

Since 2009, Justice Canada has succeeded both in strengthening existing F/P/T partnerships related to the DTCFP, and in establishing new partnerships. Footnote 19 Although some DTCFP funding recipients continue to be NGOs as opposed to provincial governments, DTCFP officials have established connections with all provincial and territorial jurisdictions, in particular through the Ad Hoc F/P/T Working Group on DTC Efficiencies and Resource Allocations (mentioned in Section 4.1.1). This group is currently considering appropriate F/P/T oversight of federally funded DTCs, and how to distribute the DTCFP budget (of $3.6 million) across jurisdictions interested in receiving federal funding for DTCs.

Current pilot site funding provides support for some cost categories that are more appropriately provincial responsibility. The AD Hoc Working Group acknowledged that more efficient funding approaches were needed. The DTCFP is slowly evolving in its approach to funding in a number of ways. For example, in 2012, the funding recipient for the Edmonton DTC moved from the John Howard Society to Alberta Justice. Moving to a federal/provincial funding relationship has allowed for improved accountability and efficiencies. As such, federal funding that was previously allocated to administration fees was redirected to direct treatment and rehabilitation costs. As it works to identify unique costs of drug courts, the Working Group is considering a provincial role in administering and funding drug courts in collaboration with the federal government. Footnote 20

In addition to considering administration issues, the Ad Hoc F/P/T Working Group on DTC Efficiencies and Resource Allocations is working on providing structural guidance to DTCFP-funded DTCs. This working group has recommended nine guiding principles for the operation of DTCs:

  1. access to a continuum of drug and other related treatment and rehabilitative services is integrated with justice system case processing;
  2. abstinence or reduction in use of illicit drugs is monitored by frequent substance testing;
  3. ongoing case management provides social support necessary to achieve social reintegration for the participant;
  4. forging partnerships among courts, corrections, treatment and rehabilitation programs, public agencies and community-based organizations to enhance program effectiveness;
  5. using a non-adversarial approach, prosecution and defence counsel promote public safety while protecting participants’ Charter rights;
  6. a coordinated strategy governs the Courts’ response to participants’ compliance and non-compliance;
  7. timely, certain and consistent sanctions for non-compliance or rewards for compliance are developed;
  8. ongoing judicial interaction with each participant is essential; and
  9. appropriate flexibility in adjusting program content, including incentives and sanctions, to better achieve program results with particular groups such as women, Aboriginals and minority ethnic groups.

Many of these guiding principles are in line with internationally recognized DTC principles accepted by Public Prosecution Service of Canada and very similar to key DTC elements and best practices identified by other countries. Footnote 21

4.2.2. Program Admissions and Reach

Eligibility and admissions

The DTC literature identifies a few best practices related to eligibility determinations:

The Ad Hoc F/P/T Working Group on DTC Efficiencies and Resource Allocations follows these best practices in its recommendations, particularly with regard to defining the DTC target offender population. In addition to targeting offenders with serious addictions to illicit use of scheduled drugs, the Working Group recommended that DTCs target offenders who have been identified as a risk to re-offend.

The eligibility criteria and process used by DTCs follow many of the best practices:

The Safe Streets and Communities Act creates mandatory minimum penalties for serious drug offences and allows courts to delay sentencing of drug-addicted offenders who attend provincially approved and court-supervised treatment programs (see also Section 4.1.1). Some DTCs believe that more lower-risk clients may apply to the DTCs.

Some DTC representatives did not have concerns with admitting lower-risk clients and believe that the DTC admission criteria should be more flexible (14%). They reported that admitting lower-risk clients could be better for the participants and/or the program generally.

Generally, survey respondents believe that admission criteria and the screening process are appropriate (77% and 69%, respectively). The main issue with admissions, from the perspective of some survey respondents (37%), is the lack of capacity to handle more participants given current resources. Conversely, 45% of respondents believe their DTC could handle more clients.

Program reach

The best practices literature points to the importance of DTCs to reach historically disadvantaged groups (NADCP, 2013, p. 11). The DTCFP acknowledges this by having as one of its objectives to promote and strengthen the use of alternatives to incarceration (with a particular focus on youth, Aboriginal men and women, and street prostitutes).

Survey results indicate that DTCs are experiencing some difficulties reaching these intended target groups, in particular Aboriginal men and women, women generally, street prostitutes and youth (see Table 6 ). Respondents who believe there are difficulties attracting certain groups provided suggestions for how DTCs can expand their reach: place more effort in increasing awareness of the DTC among lawyers, probation, and not-for-profits that work with the groups; offer specific incentives to attract women, such as child care and housing; increase the range of programming options that are targeted to these groups; collaborate with key stakeholders, such as Aboriginal advocacy groups; and prioritize these targeted groups in the DTC’s waitlist.

Table 6: Difficulties Attracting Target Groups
Q13: Are you experiencing difficulties attracting any specific target groups? (n=54)
No/None 17%
Aboriginal men and women 28%
Women 28%
Street prostitutes/sexually exploited by prostitution 20%
Youth (aged 18-24) 19%
Minorities (racialized men, women, youth) 6%
Retention is bigger issue 4%
Gay/lesbian/bi-sexual/transgendered 2%
Treatment in French 2%
Other 4%
Don’t know 17%
No response 6%

Source: Survey of DTC stakeholders and staff

Note: Respondents could provide more than one answer; total sums to more than 100%.

Administrative data from DTCIS confirm some of these difficulties, although the findings are inconclusive, as data on the number of potentially eligible youth, Aboriginal peoples, street prostitutes, or even women generally are not available. However, a comparison across DTCs as well as with the 2009 evaluation results provides support for the conclusion that the DTCs continue to struggle to reach these marginalized groups.

Table 7: Participant Characteristics (2009-10 to 2013-14)
  Edmonton Ottawa Regina Toronto Winnipeg Overall
Overall number of participants 165 162 169 332 190 1,018
Gender Male 66% 66% 66% 74% 62% 68%
Gender Female 35% 35% 34% 26% 38% 32%
Table 7a: Participant Characteristics (2009-10 to 2013-14) - Age
  Edmonton Ottawa Regina Toronto Winnipeg Overall
18–24 15% 10% 23% 6% 32% 16%
25–30 33% 29% 26% 17% 32% 26%
31–35 18% 15% 17% 15% 16% 16%
36–40 13% 17% 12% 22% 7% 15%
41–45 14% 12% 11% 15% 7% 12%
46–50 5% 12% 8% 16% 5% 10%
50+ 2% 6% 4% 10% 2% 5%
Mean age 33 35 33 39 30 34
Median age 31 34 31 39 27 33
Table 7b: Participant Characteristics (2009-10 to 2013-14) - Ethnicity
  Edmonton Ottawa Regina Toronto Winnipeg Overall
Caucasian 60% 85% 38% 54% 65% 59%
Aboriginal 18% 7% 52% 3% 21% 17%
Other visible minorities 8% 2% 2% 11% 2% 6%
Black 1% 4% 1% 11% -- 5%
Métis 10% 1% 7% <1% 5% 4%
Unknown 3% 1% 1% 21% 8% 9%

Source: DTCIS data.

Note: Percentages may not sum to 100% due to rounding.

4.2.3. Treatment Component

Best practices related to the provision of treatment in a DTC program highlight the importance of evidence-based care; offering participants a continuum of treatment services; tailoring services to address particular needs related to gender, ethnicity and mental health; and providing some sort of continuing care post program. Best practice literature also makes recommendations concerning appropriate length of DTC programs and appropriate frequency of treatment. This section discusses each of these aspects of the DTCs’ treatment components.

Evidence-based practice

Best practice sources highlight the importance of ensuring evidence-based care for DTC participants. This involves using standardized assessment tools to appropriately align care to participants’ needs, as well as ensuring that selected treatment approaches are supported by evidence demonstrating their effectiveness, both for the level and type of addiction they are being used to treat, and for the age, race and sex of the individual receiving treatment (BJA, 2004; NADCP, 2013).

The Risk-Need-Responsivity (RNR) model Footnote 23 is an evidence-based approach for aligning DTC treatment with participants’ needs. Studies indicate that adherence to RNR principles is associated with greater reductions in recidivism as well as an increased effectiveness of drug courts (Andrews & Dowden, 2007; Bonta et al., 2010; Gutierrez & Bourgon, 2009; Gutierrez, 2012; Somers, Rezansoff, & Moniruzzaman, 2013). As such, RNR is considered a best practice in DTC design.

RNR has three core principles:

  1. the “risk principle”, which involves matching the level of service provided to offenders to their risk to re-offend;
  2. the “need principle”, which involves assessing offenders’ criminogenic needs and targeting them during treatment; and
  3. the “responsivity principle”, which involves tailoring cognitive-behavioural interventions to offenders’ particular learning styles, motivations, abilities and strengths (in order to maximize their ability to learn from the intervention) (Bonta & Andrews, 2007).

Therefore, RNR involves using an analysis of offenders’ risk to re-offend to guide the selection of interventions; according to RNR principles, the type and intensity of services provided to offenders should be dictated by their risk level, their criminogenic characteristics (i.e., their specific needs related to their criminal behaviour), and other personal characteristics (Gutierrez, 2012).

There is evidence of adherence to the RNR principles among the DTCs — although the RNR-related processes used by each DTC and the extent to which the DTCs carry out RNR vary. Internal documents indicate that most DTCs, with the exception of Toronto, do some form of risk assessment on their clients. The tools and processes used by each DTC (except Toronto) are described briefly below. All tools described adhere to the principles of RNR and have been validated.

Table 8: DTC Risk to Re-offend Assessment Tools
DTC Tool Description
Edmonton Level of Service Inventory — Revised: Screening Version (LSI-R-SV) and Service Planning Instrument (SPIn)

The LSI-R-SV is used to predict violent recidivism and probation violations as well as institutional misconduct among incarcerated offenders. The LSI-R-SV produces a complete summary of dynamic risk areas in various areas (including criminal history, employment, family/marital issues, companions, alcohol/drug dependence, emotional/personal issues, and attitude/orientation) that may require further assessment and possibly intervention. The LSI-R-SV is able to predict violent recidivism and violations among probation samples while under community supervision, and institutional misconduct among incarcerated offenders (MHS, 2014).

The SPIn is an assessment and case planning tool designed for use “in adult probation, parole, and other correctional settings where there is a requirement to assess risk of recidivism and identify service needs” (Orbis Partners Inc., 2014, p. 1). It is used for assessing risk, need, and protective factors, and results are intended to be used in the development of case plans (Orbis Partners Inc., 2014).
Ottawa Level of Service Inventory Ontario Revised (LSI-OR) The LSI-OR was developed because Ontario wanted a common risk/need assessment tool for institutional and community correctional workers to support continuity of care (Girard & Wormith, 2004). The tool covers eight general risk/need subscales related to criminal history, education/employment, family/marital, leisure/recreation, companions, substance abuse, pro-criminal attitudes, and antisocial pattern, as well as two specific risk/need subscales related to personal problems with criminogenic potential and history of perpetration. The tool also provides a mechanism for including professional discretion through a clinical override, which can be used when the clinician’s professional assessment differs from the results of the tool. Studies have found the tool to be reliable and to have predictive validity with both probationers and incarcerated inmates (with greater predictive validity with the latter group) (Girard & Wormith, 2004).
Regina Saskatchewan Primary Risk Assessment Tool (SPRA) The SPRA examines risk factors predictive of criminal recidivism including criminal history, residence stability, education/employment, financial situation, family/marital relationships, peers, substance use, pro-criminal attitude, antisocial behaviour, and self-management awareness. It also measures the probability of recidivism (Government of Saskatchewan, 2012). Research has found “strong and significant correlations…between recidivism variables and the SPRA score” (Patrick, Wormith, & Orton, 2013, p. 7).
Toronto Not used N/A
Vancouver Corrections Risk-Needs Assessment (CRNA) (formerly called the Community Risk-Needs Assessment) The tool evaluates where participants fall on a risk scale, by looking at both static (i.e., unchanging) risk factors (e.g., prior assault convictions) and dynamic factors related to needs (housing, employment, relationships, substance abuse, etc.). A community peer review process conducted in 2005 found that the CRNA tool used by the Vancouver DTC is effective at predicting the general risk of re-offending (British Columbia Ministry of Public Safety and Solicitor General, 2010). Risk assessments are conducted by probation officers, who share the results of the risk assessment analysis with the care team. Risk assessment information is used to develop a case management plan for each participant, which matches supports and supervision to the participant’s CRNA score.
Winnipeg Level of Service/Case Management Inventory (LS/CMI) This tool measures the risk and need factors of late adolescent and adult offenders, and it is intended for use in treatment planning and client management (MHS, 2014). Through these risk assessments, a risk/need profile for each participant is developed and each participant is assigned a risk level. Completed LS/CMI risk assessment forms outline specific risk factors for each participant (family history, history of assault, mental health issues, personal problems with criminogenic potential, pro-criminal attitudes, antisocial behaviours, prison experiences, etc.) and identify special responsivity considerations (recommends treatment options/foci to address specific risk factors/needs — for example, counselling that addresses childhood victimization). The LS/CMI is a validated tool that has been shown by many studies to have strong predictive validity concerning recidivism (Andrews, Bonta, & Wormith, 2006; Campbell, French, & Gendreau, 2009; Guay, 2012; Manchak, Skeem, Douglas, & Siranosian, 2009; Rettinger & Andrews, 2010).

Even though the risk assessments conducted by some DTCs factor directly into treatment planning, this is not the case for all DTCs. For example, formal risk assessments are not used in the development of treatment plans in the Winnipeg or Toronto DTCs. In Winnipeg, risk assessments are conducted by the probation officer, and the results are used primarily for evaluation rather than treatment purposes; counsellors do not make use of the risk assessments in selecting and recommending treatment interventions for participants. In Toronto, the DTC program does not conduct risk assessments, but bases the selection of interventions more informally on consideration of a number of factors related to risk to re-offend, including participants’ current record, charges and patterns of violence. In contrast, Vancouver uses risk assessment results in developing treatment plans and keeps the results in participants’ files.

As some studies have shown that full adherence to all three RNR principles is associated with the greatest reductions in recidivism (compared to if only one or two principles are followed) (Andrews & Dowden, 2007; Gutierrez, 2012), it may be worth considering how DTCs can make greater use of risk assessments to aid in the “responsivity” aspect of the RNR model. According to Gutierrez (2012), to increase adherence to RNR, DTCs, in general, should begin by making greater use of validated risk assessment tools to assist in identifying treatment targets (beyond those solely related to substance abuse) and matching services to offenders’ needs. Marlowe (2012) believes that the assessment of prognostic risk and criminogenic needs should be completed before the requirements of the program are determined. He also mentioned that when the assessments are performed by different evaluators or agencies (i.e., probation officers and treatment clinical officers), the results of the assessments should be combined so that each participant can be assigned to the appropriate level for treatment and supervision.

Evaluation results also may be pointing to a potential opportunity for increasing adherence to, and realizing greater benefits from, RNR through provision of RNR-specific training. Given that very few survey respondents identified RNR as a method for ensuring appropriate treatment for participants (see Table 9 below), and given the inconsistent or impartial application of RNR principles in some DTCs, it may be that detailed knowledge of RNR and its benefits is lacking among DTC stakeholders. In a 2010 study of an RNR-based training program for probation officers, Bonta et al. (2010) found that training DTC staff in evidence-based principles of the RNR model improves both adherence to RNR and the extent to which its positive effects are realized.

Use of risk assessment tools, however, is not the only example of DTCs’ incorporation of evidence-based practice. In addition to performing risk assessments on clients, the Edmonton, Ottawa and Toronto DTCs use a number of other assessment tools to assist in predicting treatment compliance and outcomes and developing treatment plans appropriate to individual participants’ needs. Many of these addiction-related assessment and treatment planning tools used by the DTCs (including the Addictions Severity Index [ASI], Global Assessment of Functioning, Stages Of Change Readiness and Treatment Eagerness Scale, Behaviour and Symptom Identification Scale [BASIS-32], Drug History Questionnaire, Drug Taking Confidence Questionnaire, Treatment Entry Questionnaire, Alcohol Dependence Scale [ADS], and Drug Abuse Screening Test [DAST]) are verified, in the sense that they are recognized by the University of Washington’s Alcohol and Drug Abuse Institute (ADAI), and are listed in the ADAI Library Footnote 24. Furthermore, ASI, BASIS-32, DAST and ADS are identified by the ADAI Library as widely used measures with proven reliability and validity (University of Washington, 2014b).

Survey results provide additional evidence of the DTCs’ efforts to use an evidence-based approach to assess treatment needs and tailor treatment to the individual needs of participants. When asked how the DTCs ensure that treatment is appropriate for participants’ needs, most respondents identified practices related to the development of individualized treatment plans and the administration of evidence-based risk and/or needs assessments. The development of culturally appropriate treatment (discussed in greater detail below) was also a commonly mentioned practice for ensuring appropriate treatment (see Table 9 ).

Table 9: Appropriateness of Treatment for Participants’ Needs
Q29: How do you ensure that treatment is appropriate for participants’ needs? (n=19)
Individualized treatment plans 37%
Evidence-based risk/needs assessment 32%
Culturally appropriate treatment 21%
Health care provider available 16%
Frequent review of treatment plans 11%
Access to mental health assessments/screen for mental health 11%
Learning styles accounted for (visual, auditory) 11%
Treatment plan to address full scope of issues (immigration, health, income) 11%
Incorporate client input (they sign contract) 5%
Use RNR model 5%
Use RNR’s principles (but not use specific model) 5%
Treatment based on behaviour therapy 5%
Other 21%
No opinion/don’t know 11%
No response 21%

Source: Survey of DTC stakeholders and staff

Note: Respondents could provide more than one answer; total sums to more than 100%.

Continuum of care, with a variety of treatment options

Best practices literature recommends that DTCs offer a continuum of care that includes a variety of treatment and rehabilitation services (detox programs, residential treatment, sober living day treatment, intensive outpatient treatment, etc.) (NADCP, 2013). The continuum of care concept involves providing an integrated system of care that “guides and tracks patients over time through a comprehensive array of health services spanning all levels of intensity of care” (HIMSS, 2014, p. 1); therefore, satisfying this best practice involves both providing DTC clients with extended care over a period of time, and assisting clients in navigating “the system” in order to meet their full spectrum of needs. This best practice is in accordance with the RNR model in its emphasis on matching service provision to individual needs.

Evaluation results indicate that DTCs are providing a continuum of care in terms of serving clients over a period of time, guiding them through a comprehensive and individualized treatment plan, and providing and/or referring clients to a variety of treatment and rehabilitation services. All DTC programs guide clients through a series of stages. Although the stages vary somewhat among DTCs, typically these stages include assessment, orientation/stabilization, intensive treatment, maintenance, and continuing care/reintegration. In addition, although approaches to treatment provision vary (with some sites providing most services in house and others referring clients almost entirely to other treatment organizations), all DTCs provide services that go beyond substance abuse treatment to address a wide range of needs. All DTCs provide both group and individual counselling and either provide directly or refer clients to a wide range of additional services as necessary — including residential or day addictions treatment programs; secure housing, recovery homes, and supervised residences; courses on criminal and/or addictive thinking, parenting courses, literacy courses; continuing education; training and employment services; withdrawal management services, including methadone treatment; mental, physical and dental health services; stabilization groups that deal with anger management or post-traumatic stress; and cultural resources and culturally appropriate treatment services. In addition, some DTCs assist clients in meeting needs for transportation (through provision of bus tickets), food (through provision of vouchers or meals), and physical activity (through provision of gym memberships), and provide opportunities for pro-social activities, such as sports and meditation.

During case studies, interview participants — including graduates and clients from all four DTCs — generally expressed satisfaction about the phases of treatment and various types of treatment activities offered by the DTCs. In particular, case study participants mentioned benefitting from a variety of program elements, including the group and individual counselling sessions, training on criminal and addictive thinking, and requirements to attend community supports. According to one graduate, the DTC program deals with “all aspects of addiction — the physical, the mental, the emotional, [and] the social”.

Meeting the needs of DTC target populations

In addition to providing a variety of treatment options for all participants, best practices note the importance of providing relevant treatment based on ethnicity, age, gender, mental health, and other participant characteristics (BJA, 2004). This is in line with recommendations to ensure that treatment is more responsive to participants’ needs and, therefore, more effective.

Evaluation results are mixed when it comes to meeting the needs of the DTC target populations. As discussed in Section 4.2.2, the DTCs have experienced difficulties reaching their target groups and, as will be discussed in Section 4.3.1, a much lower proportion of Aboriginal, Métis, Black and other visible minority participants successfully complete the program than Caucasian participants.

Survey respondents and case study interviews indicate that, in general, the DTCs are meeting the needs of their target populations with respect to age, gender, Aboriginal ancestry, mental health and physical needs. The majority of survey respondents agreed that the DTCs adequately tailor programming and treatment considering gender (88%), physical health status (86%), mental health status (79%), and age (75%), and that they provide programming designed to meet the needs of Aboriginal men and women (62%). Case study participants generally supported the survey findings on the responsiveness of the DTCs to certain key target groups — particularly with regard to women and Aboriginal participants.

The subsections below discuss the case study findings.

Women

Almost all women interviewed across the four DTCs indicated having participated in some form of women-specific treatment activities and noted that there is a continued need for these types of supports. Additionally, men reported that gender-specific programming, mainly in the form of group sessions, was available to them as well.

Examples of women-only activities identified by case study participants include group therapy and the ability to interact with a female counsellor to discuss sensitive issues. Many of the women across DTCs recognized the need for women-only treatment activities, especially when participating in group therapy. Many of them indicated that some gender separation was required to provide a level of comfort for women who may not want to discuss particular issues with their male counterparts. Specifically, a few reported that they felt more “comfortable” and “safe” to discuss certain issues with other women — particularly relationships, involvement in prostitution, and sexual abuse/assault.

The importance of and need for gender separation, specifically in group discussions, was also echoed by some men. Like the women, some men reported that gender-specific groups are helpful because there can be some discomfort when discussing certain issues in a co-ed group setting — specifically, issues relating to drug use and sex. A few men also mentioned that gender-specific groups were especially necessary for women, as they are faced with particular issues that they may not feel comfortable discussing in mixed groups.

Aboriginals

Participants from all four case study sites indicated that Aboriginal-specific programming was available. Almost all Aboriginal case study participants had access to and participated in Aboriginal-specific programming. In addition, many non-Aboriginal case study participants also took part in Aboriginal-specific activities.

Most case study participants from two sites, including all Aboriginal case study participants, knew of or participated in Aboriginal-specific treatment activities. Aboriginal-specific treatment elements identified by case study participants included incorporating “traditional” group sessions into regular DTC programming, providing lessons on Aboriginal culture, using sharing circles, bringing Elders in on a regular basis to teach clients about Aboriginal history and tradition, allowing clients to “smudge” in designated healing rooms, and allowing participants to take part in cultural practices such as Sundance, sweats, chants or tipi teachings.

Some non-Aboriginal case study participants expressed interest in Aboriginal-specific programming and reported that they benefited from participating in these types of activities — specifically by learning about an unknown culture and applying teachings to their own personal experiences. On the other hand, a few participants expressed concerns regarding what they considered to be “forced” participation in Aboriginal-specific treatment activities. Specifically, case study participants mentioned that some DTC clients do not agree with Aboriginal teachings and values or feel uncomfortable with participating in unfamiliar activities such as spiritual teachings, smudging or chanting. One participant felt that the emphasis on Aboriginal activities excludes the cultures of other DTC clients.

Gaps in treatment programming

Case study participants and survey respondents identified few gaps in programming. Survey respondents were less certain about DTC responsiveness to the needs of other visible minorities or new immigrants; less than half of survey respondents agreed that DTCs provide programming designed to meet the needs of other visible minorities, and less than one-third agreed that they provide programming designed to meet the needs of new immigrants. When asked to give suggestions on how DTCs can better serve the needs of target populations, some survey respondents suggested offering more tailored programming (12%), addressing accessibility issues (in particular by offering more French services, after hours services, and child care supports [12%]), and increasing staff and resources (11%).

Some case study participants mentioned that having more counsellors would allow DTC clients to spend more time with participants and “go more in-depth” with them, and more funding would help DTCs reduce waiting lists for certain services, provide more transitional housing for clients, and allow DTCs to accept more clients into the program. Like survey respondents, a few case study participants mentioned that having after hours services (e.g., a telephone number to call after hours if they are struggling) would be beneficial. Other suggestions offered by participants for improving treatment services include reducing group sizes, separating program tracks so that clients who have been in the program longer do not have to repeat material in group sessions when new clients are accepted into the DTC, and increasing the involvement of alumni and others with “lived experience” to more effectively “reach” clients. It should be noted, however, that many case study participants from all four DTCs — representing current clients, graduates and non-completers — said that the DTC programs operate well, and that they would not change anything about them.

Duration and frequency of treatment

Best practices offer some guidance on appropriate length of time in the program and frequency of individual counselling sessions. Even though best practice sources vary somewhat in their recommendations about program duration and identify the importance of maintaining some flexibility in “dosing” guidelines, studies have indicated better outcomes for participants who take more than eight months and less than 16 months to complete the program (NADCP, 2013).

DTCIS data shows that, while some DTC participants have taken less than eight months or more than 16 months to complete the program, the median length of time that participants have spent in the program prior to graduating is around 14 months (see Table 10). Footnote 25

Table 10: Length of Time in Program (in Days)
  Graduated (n=239) Did not complete program (n=655)
Mean 505 352
Median 441 223
Standard deviation 224 364
Minimum 51 1
Maximum 1,449 1,914

Source: DTCIS

As to counselling frequency, the National Association of Drug Court Professionals recommends that case managers or treatment providers meet with DTC clients for individual sessions at least once a week in the early phases of the program (NADCP, 2013).

Post DTC: Continuing care

Providing continuing care is identified as a best practice for DTCs. Continuing care can be provided in a variety of ways, including through relapse prevention, the development of a continuing care plan, connecting clients to peer or community support groups, and/or providing some form of aftercare (NADCP, 2013).

All DTCs offer some type of continuing care in the form of training clients for relapse prevention, developing a continuing care plan with clients, and/or connecting clients to a peer support group or other community supports. Currently, only Toronto offers a formal aftercare program; however, Edmonton has an alumni group in which graduates can participate, and case study participants mentioned plans in place for the development of an alumni group in Winnipeg. In addition, in Winnipeg, Vancouver and Ottawa, graduates are welcome to return to the DTC centre and meet with their case managers or counsellors and take part in individual counselling sessions if they require support after the program. In Ottawa, graduates can also attend a relapse prevention group which meets weekly for a period of approximately four to five months.

Evaluation results, however, indicate potential room for improvement in the provision of continuing care or aftercare services; survey respondents and case study participants expressed concern about lack of and need for aftercare services. Almost one-third of survey respondents (32%) identified aftercare or continuing contact with participants as a factor that would make it more likely for DTCs to achieve their goal of reducing criminal recidivism post program.

4.2.4. Court Component

Regarding the court component of DTC operation, best practice sources recommend that DTCs administer fair, predictable and consistent consequences in response to participants’ behaviour, and that consequences should be administered “in accordance with evidence-based principles of effective behaviour modification” (NADCP, 2013, p. 26). More specifically, in terms of predictability, consistency and fairness, the DTC process should:

Structure of court process

In accordance with best practices, the court component provides structure to DTC programming. Although certain elements of this component vary among DTC sites as part of DTC bail conditions, the court process for all sites generally requires DTC clients to attend scheduled court appearances (which vary in frequency across the sites), submit to random urine screens, and attend treatment. Other court conditions include curfew, boundaries or association restrictions. Footnote 26

Evaluation results indicate that the court process is generally working well. Survey respondents were generally positive about the intensity, appropriateness and stringency of the court process — with the majority of participants stronglyagreeing that the regularity and number of court appearances are sufficiently intensive (71%) and bail conditions are appropriate (51%). Case study participants generally agreed that the regular court appearances were helpful in keeping them on track toward program completion. Some noted the importance of, and expressed appreciation for, the court’s role in holding them accountable for their actions.

Although the majority of survey respondents agreed that the policy toward relapses is appropriate — neither too stringent (85%) nor too lax (76%), respondents were somewhat less certain about this aspect of the court component; while the majority of respondents strongly agreed about the appropriateness of most court components, less than half strongly agreed that the approach toward relapses is not too lax (47%). Case study participants were also somewhat divided about the leniency of the DTCs with regard to relapses — with some appreciating the “second chance” offered, and some feeling that more should be expected of DTC clients. (The quotes below provide examples of these perspectives.)

They always treated me fairly. They gave me quite a few breaks actually. They were very understanding. I should have gone to jail a couple of times but they let me out. I learned from my mistakes. They let me learn from what I’d done wrong. (Graduate)

In court, they give you a clap and tell you to keep trying. I could stand there and lie to you all you want and still get away with it. But no should mean no, three strikes and you’re out. People come up with excuses whenever they’re late or if they used. There should be three warnings and you’re gone. This place should be tougher. Don’t mess around, don’t lie, be on time. (Non-completer)

Most survey respondents did not offer an opinion on how to improve the court component, but those who did suggested loosening certain requirements, such as curfews or when clients can begin working during the program (n=4), requiring more frequent or longer court appearances (n=3), or offering a greater variety of rewards and sanctions (n=3).

Communication of policies and procedures

Some, but not all, DTCs have detailed participant manuals or policy documents that outline the court process, expectations and consequences. As mentioned in Section 4.2.1, some DTCs are in the process of updating or developing policies and procedures manuals. As communicating policies and procedures (including court expectations and the range of court responses) in advance to clients has been associated with improved outcomes (NADCP, 2013), this would most likely be a valuable exercise for all DTCs — particularly considering that a few case study participants raised some concerns about the court decision-making process (especially with regard to decisions about sanctions and loss of privileges). In particular, these participants said they were not provided with appropriate information as to what was being shared during the pre-court meetings, were not properly informed of the basis on which decisions were being made, and were not able to properly defend themselves in court.

Behavioural responses: use of rewards and sanctions

All DTCs make use of sanctions and rewards to respond to and modify participants’ behaviours. For the most part, these are useful and effective, although evaluation results indicate some potential for improvement with regard to consistent use of sanctions.

Rewards

All DTCs present rewards to participants during scheduled court appearances for achieving clean screens and making progress in treatment. These rewards commonly include praise from the judge, gift cards to places where participants can purchase food and other necessities, curfew extensions, and reduced requirements for court appearances.

The majority of survey respondents agreed (55% stronglyagreed, and an additional 26% somewhat agreed) that rewards are used when they should be. In addition, case study participants generally indicated that rewards are helpful in their treatment. Many participants mentioned that receiving a reward yielded a positive impact — noting that rewards are an important motivating factor in their treatment and that the fact of receiving rewards gives clients a sense of pride and confidence.

I got rewards three times. I got a movie pass, a Tim Hortons’ card, and a Loblaws’ card. It makes you feel proud. Your esteem would get up. You wouldn’t feel guilty, you’re doing well. When you see other people getting them for being clean, you tell yourself that this is a goal you’re setting. You see light at the end of the tunnel, it’s worth the sacrifice. (Non-completer)

Most case study participants appreciated the positive feedback from the judge during court.

I definitely liked being praised by the judge. It felt good to slowly hear my name getting closer to the top of the list. It was good and necessary and sometimes stressful. It was a little annoying when the judge would confuse things or be a week behind. He was happy to see us do well and tell us how it is if we’re not. (Graduate)

In addition, a few case study participants mentioned that rewards, mainly gift cards, also had positive financial gains for some clients, noting that it allows them to buy items that they could not normally afford and helps clients who are unemployed with limited sources of income.

Sanctions

In addition to rewards, all DTCs make use of sanctions as a response to clients’ behaviour. Sanctions are commonly assigned for reasons such as unreported drug use, breach of curfew, as well as missed treatment sessions, urine tests, or court appearances. Common sanctions include assigning community service hours and sending clients to remand.

Case study results indicate that, in general, sanctions are a useful component of the DTC court process. Many case study participants reported that sanctions had a positive impact, noting that they were effective as a corrective measure to deter behaviour that contravenes program rules. Specifically, sanctions motivated them to avoid repeating the same offence and kept them accountable.

I was sanctioned two to three times. I spent a night in jail. I did a few hours of community service. Once I failed a drug test, and they thought I lied to them. I might’ve also missed a meeting. It was a negative experience in the beginning. You’d spend a night in jail, it was just one night. But then you’d smarten up. Most of the time, I was wrong. I put it in perspective. It becomes a positive — you don’t want to do that again. I was more willing to stay with the program. It motivated me. (Non-completer)

I got sanctioned once for dishonesty on a urine screen. I had to report the day before my test. I told the therapists, but they must report to court. They put me in jail for two days. It was a positive experience. I learned from it. I put myself in that situation. I wouldn’t let anything happen twice. It helped me. I didn’t want to let it happen again. (Graduate)

In addition, some case study participants identified that certain sanctions produced side benefits for clients, such as connecting them with social support networks or allowing them to gain relevant work experience.

Getting sanctioned actually had a positive effect on me because I did community service at the food bank and I was able to stay involved with them afterwards, doing a lot of their building renovations and maintenance work. The experience I got from that helped me a lot. I was able to get my career on track, learned a lot, and got me back in the groove. (Graduate)

Evaluation results, however, indicate room for improvement regarding the consistent and appropriate use of sanctions. Survey respondents seemed to be less certain about the appropriate use of sanctions, compared to other program elements, as less than half (42%) strongly agreed that sanctions are used when they should be. Case study participants also raised some concerns about the degree to which sanctions are used fairly and consistently. Some case study participants reported discrepancies in the severity of sanctions imposed (particularly with regard to drug use), and identified a need for greater consistency in the program’s response to sanctionable behaviour. These participants noted that the program’s response is not always the same for all clients, as some individuals may receive more lenient penalties than others for the same action. According to some, this can have negative repercussions on the attitude of other clients, as they may adopt similar behaviour and expect lighter sanctions. Moreover, a few others indicated that some clients are continually punished for sanctionable behaviour yet are never discharged from the program.

A few participants noted that it was, at times, difficult to secure community services hours with local agencies and organizations because openings were limited. This situation sometimes resulted in them receiving additional sanctions because they were unable to complete all of the required hours.

However, although case study participants raised some concerns about the fairness of the process for determining sanctions, it should be noted that almost all participants felt that they were treated fairly and with respect by judges. Case study participants frequently mentioned that DTC judges follow set rules while taking each participant’s unique situation into consideration, listen and allow participants the opportunity to explain their situation, and do not show favouritism.

4.2.5. Housing Gap

The 2009 Summative Evaluation of the DTCFP identified housing as a gap and made a recommendation that “the DTCFP should continue to include housing as an integral part of the program” (Department of Justice Canada, 2009). During the current evaluation period, the DTCFP continued to work with Human Resources and Skills Development Canada on housing pilot projects for DTC locations. Funding for the Toronto pilot was extended until 2010, and two new housing pilots (Winnipeg and Regina) were undertaken. Although both new pilots were successful (see Table 11 ), only one project (Regina) was able to continue with provincial funding, and its funding is allocated for short time periods (a month or two at a time but as of November 2014, Saskatchewan Justice has committed funding until 2017). As the experience of these pilot projects indicates, sustainability of housing for DTC clients remains an issue. This is reflected in survey results, which show that DTC stakeholders continue to consider housing a gap.

Table 11: Evaluation Results for Winnipeg and Regina Housing Pilot Projects

Winnipeg
Description of pilot projects

The Winnipeg DTC Housing Supports program aimed to provide suitable housing and housing supports for Winnipeg DTC participants upon admission –— and, in doing so, contributed to successful rehabilitation. The program involved:

  • hiring of a full-time housing support worker to assess participants’ housing needs, work with community agencies that provide housing services, and help participants find and maintain suitable accommodation;
  • funding of a transitional house for DTC clients facing housing crises or deteriorating housing situations, or those released from custody without a place to stay; and
  • hiring of house mentors to look after the transitional house and provide support to clients living there.
Evaluation findings

Two key findings from the evaluation demonstrated the success of the program in improving retention and its cost effectiveness:

  • Compared to a comparison group, Footnote 27 clients who attended the transition house were 7% less likely to be discharged from the Winnipeg DTC program.
  • The transition house per diem rate of $48 is less than the per diem rate of federal custody (estimated at $288 – $588), provincial custody (estimated at $174), and intensive residential addictions treatment Footnote 28 ($128–$188).
Regina
Description of pilot projects

“Kate’s Place” was a two-year housing pilot project to support women participating in the Regina DTC. One purpose of the housing project was to determine if supportive housing could improve women’s discharge and graduation rates (which were below men’s graduation/completion rates).

Evaluation findings

Records of residents’ characteristics on intake indicate that the program was reaching target population (those with higher and urgent housing needs — e.g., at risk of homelessness, those in risky living situations).

The evaluation found that an increase of 30% in women’s participation in the Regina DTC had been achieved in September 2012, just five months after Kate’s Place was opened. As of February 2013, women comprised 48% of all participants in the Regina DTC. Additionally, Regina achieved its goal of a 10% reduction in women leaving the Regina DTC by February 2013.

Sources: (Smithworks Surveysolutions, 2013; Weinrath, 2014)

4.2.6. Adequacy of Performance Measurement Activities to Support DTCFP Monitoring and Reporting Requirements

Due to issues with completeness and consistency of the data, the DTCIS could not be used to support the 2009 Summative Evaluation. As part of its action plan to respond to the evaluation recommendations, the DTCFP stated that it would “continue to monitor monthly uploads of site DTCIS data to ensure that core performance measures are being captured in a manner that provides comparable performance data over time” and that “DTCIS system modifications shall be made as required”.

The DTCIS has been updated during the evaluation period and additional mandatory fields have been developed in order to improve the quantity, quality and consistency of data collection to support monitoring. DTCIS data has supported the development of a series of research reports for each DTC on the performance of DTC participants.

Although the DTCFP has worked to improve the DTCIS, the evaluation found that those who use the database still see room for additional improvements. Respondents who use DTCIS for reporting purposes (n=15) generally found reporting requirements reasonable (60%, or n=9). Of those who access or use the DTCIS (n=24), less than one-third (29% or n=7) considered the information in the DTCIS effective in supporting the DTCs. A similar percentage of respondents thought that the DTCIS captures the necessary information for case management (29%), adequately captures the work of the DTCs (21%), and provides helpful statistics for case management and/or the operations of the DTCs (29%). Footnote 29 Given that the DTCIS should be useful to track and understand performance of the DTCs as well as manage its caseload, those using the DTCIS should see utility in the database. The evaluation results show that the DTCIS remains a work in progress.

4.3. Performance — Effectiveness

According to the 2009 Treasury Board Policy on Evaluation, evaluating performance involves assessing effectiveness, as well as efficiency and economy. The subsections below discuss the effectiveness of the DTCFP — in other words, the extent to which the Program is achieving its expected outcomes.

4.3.1. Participant-Level Outcomes

Successful retention of participants in the DTCs

Retention is an important measure of success for the program. Studies of DTCs have found that higher retention rates are associated with better outcomes, including lower recidivism (Belenko, 2001 cited in Fulkerson, 2012).

The retention and graduation rate for the five DTCs that input data into the DTCIS was calculated based on the known status of participants in the program as of March 31, 2014 (see Table 12).

Table 12: Status in Program as of March 31, 2014
  Number Percentage
Applied but not accepted into the program 236 18%
Assessment, interview 80 6%
Treatment 124 9%
Successfully completed the program 239 18%
Did not complete the program 655 49%
Total 1,334 100%

Source: DTCIS

The evaluation used the same formula for retention and graduation rates as the 2009 evaluation.

Retention rate = (active participants + graduates)/admissions

Graduation rate = graduates/(graduates + terminations prior to graduation)

Applying these formulae, the results are a retention rate of 36% and a graduation rate of 27%. For the 2009 evaluation, an overall retention/graduation rate could not be determined, but the retention rate ranged from 34% to 55%, and the graduation rate ranged from 6% to 36%. Footnote 30 Thus, the retention rate in 2014 is on the low end of the range found in the 2009 evaluation, but the graduation rate is on the high end.

DTCIS data showed no difference in program completion based on gender, as the same proportion (27%) of men and women graduated from the program (see Table 13 ). A higher proportion of Caucasians graduated (32%) compared to Métis (25%) or other visible minorities (24%). Aboriginal participants had the lowest graduation rate at 15%. These results may indicate that programming could better address cultural differences or that the Aboriginal cohort has higher needs that go beyond the scope of the court.

Table 13: Characteristics of Participants by Success in the Program - Gender
  n Did not complete program Successfully completed program
Male 603 73% 27%
Female 291 73% 27%
Table 13a: Characteristics of Participants by Success in the Program - Age
  n Did not complete program Successfully completed program
18–24 141 76% 24%
25–30 231 74% 26%
31–35 143 76% 24%
36–40 141 74% 26%
41–45 109 67% 33%
46–50 85 74% 26%
50+ 44 61% 39%
Table 13b: Characteristics of Participants by Success in the Program - Ethnicity
  n Did not complete program Successfully completed program
Caucasian 519 68% 32%
Aboriginal 162 85% 15%
Other visible minorities 49 76% 24%
Black 40 78% 22%
Métis 36 75% 25%
Unknown 88 80% 20%

Source: DTCIS

Note: Percentage may not sum to 100% due to rounding.

Most participants did not voluntarily leave the program. Failure to follow program guidelines was the primary reason for failure to complete the program. In particular, DTC non-completers most often either breached program guidelines or re-offended. Just over one-quarter (28%) of non-completers dropped out of the program voluntarily. For 26% of non-completers, no reason was specified in DTCIS (see Table 14 ).

Table 14: Reasons for Participants not Completing the Program (n=655) - Program initiated — failure to follow guidelines
  Number Percentage
Breach of program guidelines 110 17%
Re-offend 69 11%
History of non-compliance 42 6%
Lack of participation 33 5%
Inconsistent attendance 26 4%
Outstanding matter 8 1%
Involvement in prostitution 2 <1%
Past program failures 1 <1%
Total — failure to follow guidelines 291 44%
Table 14a: Reasons for Participants not Completing the Program (n=655) - Program initiated — due to participant characteristics
  Number Percentage
Mental health issues 5 1%
High risk of violence 3 1%
Diversion more appropriate 1 <1%
High addiction motivation 1 <1%
Total — participant characteristics 10 2%
Table 14b: Reasons for Participants not Completing the Program (n=655) - Offender initiated
  Number Percentage
Did not return 104 16%
Accused no longer interested 82 12%
Total — offender initiated 186 28%
Table 14c: Reasons for Participants not Completing the Program (n=655) - Other
Number Percentage
168 26%

Source: DTCIS

Note: Percentage may not sum to 100% due to rounding.

Case study and survey respondents agreed on many of the factors that they believe led to success in the program.

Connection of participant to the DTC team. Survey respondents mentioned this factor most often (n=19). Most graduates and non-completers also reported that the DTC program team — including the judge, counsellor and probation officer — was a “very important” or “important” factor in helping them graduate from or stay in the program.

They were the root of the whole thing. Without them working together and with you, it wouldn’t have happened. They were very important. (Graduate)

Appropriate treatment programming. This was the second most often mentioned factor for retention given by survey respondents (n=14). Almost all graduates and non-completers interviewed across the four case study sites reported that addictions treatment and counselling were “very important” or “important” factors that contributed to their graduation or retention in the program.

Important. For me, the biggest [skills] that I gained were the treatment skills on dealing with triggers and coping with high stress situations and managing myself and emotions and learning healthy ways to deal with them. But I found some of the skills I had already known, so they were good reminders but I didn’t think that everything applied to me. (Graduate)

Housing. Survey respondents also pointed to meeting participants’ housing needs as a factor in retention (n=14). Case study participants confirmed the importance of housing as many of them reported that housing supports were a “very important” or “important” factor in their success.

They helped me right away. They gave me something to look forward when I got out of my halfway house. They were awesome about that. That was huge for me. That helped me stay and because I don’t have family out here so it gave me a chance. (Graduate)

When housing is not available, DTC participants may remain in settings that encourage their addictions. A few case study participants reported that they faced some housing issues when first entering the program, specifically in locating safe and proper housing free of drug use.

People in the program get stuck in the shelter right away, but that’s where they were staying before smoking crack. (Non-completer)

Education and skills. Although not specifically identified by survey respondents, most graduates and non-completers as well as a few current participants interviewed mentioned that the education and skills they learned while in the program were “important” or “very important” in their graduation or retention in the program.

Very important. This was vital. When I entered DTC, [my] education and skills surrounded committing crimes to get the money I needed to get drugs. Although I got a great deal of education and many skills on the street, in DTC they helped [me] learn that some of the skills were transferrable to a new, supportive, and positive way of life. They helped me understand that I’m not just a criminal or an addict. The life skills courses were important — I never cooked meals, I hadn’t kept a budget in years, I never had to schedule anything while I was on the street. I learned to do things on my own. (Graduate)

Personal supports/motivation. In addition to program supports, two personal issues were considered “important” or “very important” to their graduation or willingness to remain in the program by case study participants. Family was identified as an “important” or “very important” factor for participants, as many reported having family support or having reconnected with family while they were in the program. Some graduates reported that family support was not an important factor, as they either did not have any family or were not in touch with their family.

Very important. Going into DTC, I had little to no relationship with my family. They had basically written me off by that point. But when I got out of jail, I was forced to live with them with the ankle bracelet. This was big because I learned how to build that trust again. My counsellor helped me understand that my family isn’t going to forgive me overnight. I wouldn’t have been able to complete the program without my family. (Graduate)

Almost all graduates and non-completers as well as many current participants reported that their own personal willingness to change was a “very important” or “important” factor in their graduation from or retention in the program. For many case study participants, their own desire to change was above all the most important factor in recovery.

I didn’t always like it. We have a sense of resisting the things we need the most. I did go to all treatments, it was mandatory. In my mind, I had to succeed. I couldn’t fail, I had no choice. It was difficult at times. It wasn’t a “get out of jail card” for me, it was life changing. They dealt with all aspects of addiction, the physical, the mental, the emotional, the social. This was the first thing that I actually started and finished in my life. (Graduate)

The above two personal factors that DTC participants identified as important to success, when not present, are the two main difficulties for retention, according to survey respondents and case study participants: an unsupportive environment and negative associations related to peers, family or living arrangements (e.g., high drug use in area where participant lived); and the lack of client motivation to be in the program (e.g., not yet ready to change). Some case study participants reported that personal issues, such as dealing with their addiction and with past experiences, as well as their negative attitude toward treatment, made it difficult at times for them to continue on in the program. Survey respondents and a few case study participants also mentioned that adapting to the DTC structure was difficult for some participants.

At first, I didn’t like being told what to do. But I understand now that they need the structure. As addicts, we were used to running our own lives, we’re not used to obeying rules or having structure. At first, I didn’t want to be here. (Non-completer)

Participants’ compliance with DTC conditions

As noted earlier, DTC bail conditions include attending scheduled court appearances (which vary in frequency across the sites), submitting to random urine screens, and attending treatment. Other conditions like curfew, boundaries or association restrictions can also be imposed. The available information indicates that DTC participants generally appear at the scheduled court appearances. Graduates appear to be more likely to have a valid reason for non-appearance than those participants who have been discharged from the DTC.

A 2013 study of the five DTC sites that use DTCIS found incomplete data on court appearances (dates of appearance, attendance, reasons for non-attendance) for participants who have exited the program through graduation or non-completion (e.g., discharged). DTC participants generally appeared at the scheduled court appearances; however, for between 9% and 20% of court appearances, depending on the DTC, participants failed to appear. Graduates were more likely to have a valid reason, such as being in a residential treatment facility, than those who were discharged.

These results appear to align with the DTCIS data analyzed for this evaluation. Between April 1, 2009 and March 31, 2014, DTC participants were in attendance for 84% of the scheduled court appearances, and for 16% of scheduled court dates, DTC participants did not attend.

Case study interviews demonstrated the importance of court appearances to participants’ progress in the DTC. Many case study participants indicated that the regular court appearances were helpful in keeping them motivated and enabling them to graduate from the program. For example, many of them reported that the regular court appearances were essential in keeping DTC participants accountable. Some participants reported that the regular court appearances signified that the program was still part of a serious legal process and that sanctions, especially remand, were important motivating factors. According to a graduate, “Knowing that I could be sanctioned and…sent to jail for a few days or [lose] privileges was a huge factor in keeping my eye on the goal”. Case study participants also noted that clients are not only accountable to the judge and court but to their peers as well. Disclosing a failed drug test and admitting to use in court in the presence of others is a way in which clients are kept accountable, as they may feel remorse and guilt for disappointing others, especially those who are doing well in the program.

Regular court appearances are a huge part of the recovery process. That keeps you accountable. When you go in there and they read your screens to everyone, even if you didn’t admit to anyone that you used, they see if your screens were dirty and they know what for. All the people are looking at you and maybe you were the only guy they were looking up to before that. You let them down. (Graduate)

According to some case study participants, structure was also an important component in helping them graduate from or stay in the program, noting that, like the regular appearances for treatment, a routine is necessary if they are to successfully change their lifestyle.

Participants’ progress in reducing illicit drug use

Reducing participants’ drug use during and after the program is the key outcome for the DTCFP. To track participants’ illicit drug use during the program, the DTCs conduct random UDTs. Footnote 31 The evaluation was able to conduct a study of drug use during the program through an analysis of participants’ UDTs. The DTCs do not currently track post-program drug use, so the information for this outcome is based solely on case studies.

During the program

For the evaluation, a study was conducted to determine whether DTC participants’ use of illicit drugs, as evidenced by UDT results, declined during their participation in the program. The study considered UDT results of participants at three-month intervals for up to 15 months.

The results of the analysis revealed that the DTC program had a positive effect on the participants’ UDTs, with fewer “dirty” (failed) and more “clean” UDTs regardless of the participants’ final status (graduate or non-completer). See figure 1. The dirty UDTs of the participants, regardless of their status, were reduced over the period of 15 months, while the clean UDTs reached their maximum at 12 months, and then dropped to their lowest point. A possible explanation is that successful participants (eventual graduates) are not required to submit as many UDTs in later stages of the program as a reward for program compliance. In addition, although graduates have fewer dirty UDTs than those who did not complete the program, both groups have fewer dirty UDTs over the 15-month time period. The program seems to start having an effect on both groups after three months of participation. See Figure 2.

Figure 1: Participants’ UDT

Figure 1: Participants’ UDT

Figure 1 - Text equivalent

A bar chart of the participant’s UDT

Vertical Axis: Mean of UDT (values: 0-12)

Horizontal Axis: UDT

Inside the chart: two bars: Bar 1: Dirty UDT (fewer/lower UDTs mean: 4.7) and Bar 2: Clean UDT (more/higher clean UDTs, mean: 9.63)

Figure 2: UDT Results Over Time

Figure 2: UDT results over time

Figure 2 - Text equivalent

A line chart of Dirty and Clean UDTs over time

Vertical Axis: mean UDT (values: from 0-12)

Horizontal axis: Time in program: 5 categories: 0-3 months, 4-6 months, 7-9 months, 10-12 months, 13-15 months

Line 1: clean UDT

Mean of Clean UDT: 0-3 months: 9.72, 4-6 months: 10, 7-9 months: 9.57, 10-12 months:10.6, 13-15 months: 8.13

Line 2: dirty UDT

Mean of Dirty UDT: 0-3 months: 8.1, 4-6 months:5.3, 7-9 months: 3.7, 10-12 months: 3.7 , 13-15 months: 2.8

The case studies provide anecdotal evidence of the above results. All case study participants currently in DTC treatment said that they were either abstaining completely from drug use, or that their drug use has been reduced since they started in the program. Most case study participants who indicated reduced drug use described substantial reductions (e.g., from daily use to occasional use) in their drug use since entering the DTC. No case study participants currently in DTC treatment said that their drug use increased during the program.

Participants attributed their reductions in drug use largely to being held accountable for their actions through the DTC program. They believe that the DTC program caused them to think about the consequences of using drugs (prior to using the drugs). Many of these participants also mentioned the importance of regular urine screens for keeping them on track in the program.

Post program

Most case study participants who had graduated from a DTC reported complete abstinence from drug use. Even though some graduates did admit to relapses post program, they described the relapses as infrequent, “small incidents”, and said they were able to get back on track without much difficulty. Many of the graduates who had relapsed post program indicated that the program had changed their thinking about drug use; they mentioned that drawing on what they had learned in the DTC helped them to stop their use.

Even in the worst-case scenario, there are things that I have learned though DTC that you cannot take away from me, and would be the backbone for another stint of sobriety if necessary. (Graduate)

Only a few case study participants who did not complete the program reported complete abstinence from drugs after their DTC involvement; however, most of them said that their drug use is much reduced. Although they did not successfully complete the DTC program, a few non-completers, like graduates, attributed their reduced drug use post program to their DTC involvement.

I failed drug tests, and I lied about most of them at the beginning (I said I was clean when I wasn’t). At first, I didn’t care — I did what I wanted to do. As time went by, I’d get 2 months sober, I’d have a slip, I’d get 3 months sober, I’d have a slip. It got to the point where I’d buy meth, and I wouldn’t be able to do it. I’d freak out and throw it away. It started out as a negative thing, but then it turned into a positive thing. (Non-completer)

Among graduates and non-completers, the following were the most frequently mentioned factors contributing to their continued abstinence or reduced drug use:

Some graduates mentioned that maintaining connection with their DTC team has helped them to abstain from drug use. According to one graduate, “the biggest thing that has helped me stay away from drugs is staying connected with DTC”.

Participants’ access to, and utilization of, community services and supports

By connecting participants with community services and supports, DTCs not only leverage existing resources to address participants’ needs during the program, they also link participants to the broader community, which should ensure a more seamless transition post program. Survey and case study results indicate that DTC participants are being referred to a variety of community services and supports. Members of dedicated DTC teams who responded to the survey reported that they are referring clients to a variety of services in areas that respond to common DTC participant treatment needs (e.g., addictions treatment, mental health services), broader social needs (e.g., housing, education, health, employment), and culturally specific supports (e.g., services that target Aboriginal peoples or provide services in a participant’s language) (see Table 15).

Table 15: Criminal Justice and Treatment Programs and Services
Q31: To what type(s) of criminal justice and treatment programs and services have you referred clients? (n=42)
Addictions treatment 71%
Housing services 69%
Mental health programs/services 67%
Education programs/services 67%
Culturally appropriate services (e.g., services that target Aboriginal peoples, services provided in appropriate languages) 67%
Other health programs/services 60%
Employment programs/services 57%
Services specifically targeting the needs of women 55%
Life skills (cooking, financial literacy, parenting, anger management) 7%
Social supports (clothing, food bank, The Salvation Army) 5%
Income support services 5%
Daycare 2%
Other 12%
None 2%
Don’t know 2%
No response 21%

Source: Survey of DTC stakeholders and staff

Note: Respondents could provide more than one answer; total sums to more than 100%.

Based on the information available to the evaluation, the DTCs are connecting participants to community services and supports, as most case study participants were aware of the types of services listed in and were either using them or did not have an immediate need. Only a few case study participants had no knowledge of community services and supports.

Enhancement of participants’ social stability

Although quantitative data on improvements in participants’ family, work, school or housing status during their time in the program is not available, there is qualitative evidence that the DTC program has improved the social stability of participants. Overall, all participants across the four case study sites reported that their participation in the DTC program has improved their life in some way. Generally, participants said that DTC made their life “better”, “more positive”, that they are “happier”, or that they would “be in jail” or “dead” without the program. Many case study participants mentioned that the DTC program had contributed to improving specific aspects of their lives, including the following:

Of the various participant outcomes, the one that stakeholders believe that DTCs are most effective in addressing is improving the social stability of participants: 65% of survey respondents believe that their DTC is very effective, and 28% believe it is somewhat effective in improving participants’ social stability (e.g., housing, education and/or employment).

Although these findings suggest that the program is helping participants improve their social stability, it is difficult to draw definitive conclusions based on the information available to this evaluation.

Reduction in criminal recidivism
During the program

The DTCIS does not systematically track whether participants re-offend while in the program, although it does capture re-offending as one of the possible reasons for failure to complete the program. Because the DTCs do not have a zero tolerance policy for re-offending, the DTCIS provides an incomplete picture of recidivism among participants. Based on the available DTCIS data between FYs 2009–10 and 2013–14, 69 participants were discharged or expelled because they had re-offended, representing 7% of those admitted into the program.

Almost all case study participants interviewed said that they were either not currently engaged in any criminal activity (and did not receive any new charges) or had reduced their involvement in criminal activity since entering the program. The vast majority said that they were not involved in any criminal activity at all and had not received any new charges since entering the program.

Of the few current clients who reported a reduction in criminal activity, most were charged with a single infraction (such as theft or shoplifting) since they entered the program, while a few said that they had committed a small number of offences when they first entered the program, but that their involvement in criminal activity has since decreased. Among current clients, the most frequently mentioned factor contributing to reduced criminal activity was avoiding drug users and those involved in criminal activity. Other factors identified by a few current clients include:

Current clients did not identify any factors that may have impeded their progress in reducing their involvement in criminal activity.

Similar to current clients, most graduates and non-completers also reported little to no involvement in criminal activity while they were in the program (again, the majority said that they had no involvement at all). Of those who reported some criminal activity, a few said that they were charged for a single offence, while a few others said that they were charged for a number of offences when they began the program but that their criminal involvement progressively decreased. Common crimes reported by graduates and non-completers included breach of curfew, shoplifting and theft. Sanctions imposed in response to new charges were also described by a few graduates and non-completers, the most common of which was remand (varying from one to seven days). One graduate was required to write a letter to the judge requesting reentry into the DTC program.

Post program

Several studies point to a reduction in recidivism among DTC participants and/or graduates. From the results of their meta-analysis, Downey and Roman concluded that “it is virtually certain that the average drug court effect is a reduction in recidivism”. They found this to be true for all studies, regardless of level of rigor (2010, p. 35). Recent meta-analyses have found recidivism rates for DTCs at 8% to 14% (Latimer et al., 2006; Leticia Gutierrez & Bourgon, 2009). Some studies have also found that the effects of drug courts on recidivism rates last for years after program completion (Mitchell et al., 2012). Footnote 32

A Justice Canada study found that DTC graduates are significantly less likely to re-offend (p=.000) than participants who were terminated from the program or the comparison group (consisting of individuals who meet DTC criteria but no DTC exists in their jurisdiction, and individuals who were eligible for the DTC but refused to participate). Footnote 33 When compared to DTC graduates, those who were terminated from the program were 3.2 times more likely to re-offend, and those in the comparison group were 1.9 times more likely to re-offend.

Rates of re-offending were found to be significantly lower among DTC graduates at every point in time.

The study also found that when all DTC participants were considered (both graduates and those who did not complete the program), the recidivism rates between the comparison and the DTC groups were not statistically different Footnote 34:

The study found that 70% of DTC participants who re-offended committed non-drug offences, compared to 41% of the comparison group.

Two DTCs have had recidivism studies conducted in recent years. These studies used different methods than the Justice Canada study but had similar or even more positive results.

The Vancouver DTC also conducted a second study (the results of which were published in 2013) that investigated the comparative effectiveness of the Vancouver DTC in terms of recidivism among a number of subgroups: ethnicity, gender, prior offending, and presence of a co-occurring mental disorder. Footnote 36 Findings were that female and Aboriginal DTC participants had greater reductions in recidivism than other participants. In addition, for all participants, longer duration in the program was positively associated with reduced recidivism. The study did not find any difference in recidivism related to prior convictions or the presence or absence of co-occurring mental disorders (Somers et al., 2013). This is the only study in Canada that has looked at recidivism by these subgroups.

4.3.2. Program-Level Outcomes

Sharing promising/best practices

One of the DTCFP’s immediate outcomes is facilitating the sharing of promising practices among DTC stakeholders. This outcome is intended to support the related intermediate outcome of the development of evidence-based improvements for the DTCFP and DTCs in Canada. The 2009 evaluation of the DTCFP found that stakeholders wanted more opportunities to share information and recommended that the “DTCFP should take more measures to facilitate effective communication among key stakeholders” (Department of Justice Canada, 2009, p. 63).

The DTCFP has made efforts to address the recommendation. In particular, the key informants had expressed support for more intensive interaction with the DTCFP, such as the monthly teleconferences that occurred when the pilot sites were beginning (Department of Justice Canada, 2009, pp. 20–21). In response, the Program has reinstituted regular monthly DTC directors’ meetings. These meetings provide a forum for information sharing and peer discussion around DTCs. One or two representatives of each DTCFP-funded DTC, along with Justice Canada representatives, take part in these meetings via teleconference. Meeting minutes provide evidence of the sharing of promising approaches and best practices.

In addition, there are opportunities for face-to-face meetings. Until travel restrictions in 2013, DTCFP representatives went on annual site visits to the federally funded DTCs. Directors from some sites have also travelled to other federally funded DTCs to share information and best practices. The biannual Canadian Association of Drug Treatment Court Professionals (CADTCP) conferences also offer the possibility of training and sharing information and research on DTC-related issues. Although in the past the Program had used the CADTCP conference as an opportunity to hold face-to-face meetings for the Directors of the DTCFP-funded DTCs (Banff, October 2010), federal government travel restrictions have limited that possibility for the most recent CADTCP conference (the 5th International Training Symposium on Problem Solving Courts and Innovative Approaches to Justice — hosted by CADTCP along with the International Association of Drug Treatment Courts).

Since the last evaluation, the DTCFP reports that it has emphasized building a stronger relationship with provincial and territorial governments. Previously, if the provincial government was not the funding recipient, the DTCFP had limited and sometimes no contact with the provincial government. Now, the Program has made connections with provincial government representatives in all the locations where there is a federally funded DTC. An example of how the DTCFP is working more closely with all the provinces, regardless of whether they are a funding recipient, is the Ad Hoc F/P/T Working Group on DTC Efficiencies and Resource Allocations. The Working Group ensured that all provinces with a DTC or that are interested in a DTC could be involved in key aspects of developing a more consistent approach to DTCs, including defining key characteristics for the DTC model (common definition of DTCs, the target offender population, eligibility criteria, and successful completion).

Survey results showed generally positive responses for existing information-sharing tools, although a fairly large proportion of respondents could not provide an answer (see Table 16). The lack of awareness/use of tools, coupled with the response to the broader question of whether best practices and lessons learned are effectively shared, solicited a response of “very effective” from 6% of respondents and “somewhat effective” from 40%, which indicates that there remain opportunities to improve.

Table 16: DTC Information Sharing - Respondents who participated in or used DTC resources or activities (n=47)
Q19: Please rate the usefulness of any of the following educational/promotional resources or activities that you have used or in which you have participated. % Very Useful % Somewhat Useful % Neutral % Not Very Useful % Not at All Useful N/A
DTC websites 17% 43% 11% 6% - 23%
Department of Justice research reports 17% 40% 13% 6% - 23%
DTC police training 15% 11% 13% - - 62%
DTC presentations 40% 38% 9% - - 13%
Information sheets placed in potential DTC participants’ files 23% 17% 6% 2% - 51%

Source: Survey of DTC stakeholders and staff

Note: Rows may not sum to 100% due to rounding.

Strengthening community networks

DTC interactions with other community resources vary somewhat based on the design of the DTCs. Some DTCs provide in-house treatment services and primarily engage with other community resources through referrals. Other DTCs have community advisory committees that are part of their governance structure. Based on survey results, all DTCs consider that they have effectively created community partnerships (82%) and strengthened the network of organizations addressing drug use (65%).

4.4 Performance — Efficiency and Economy

Determining the efficiency and economy of the DTCs requires understanding the total costs of their operation, as well as the potential benefits that a DTC may offer the government and society. The most complete cost information is available for two DTCs that have provincial government departments as the funding recipients. These DTCs have more ready access to their global costs, which would include the costs of prosecution and court personnel. DTCs that have NGOs as funding recipients do not have complete cost information.

The benefits are easy to describe, but they are not as easy to value monetarily. The potential benefits are the following:

  1. Avoided or delayed prosecution and incarceration costs. If DTC graduates do not re-offend, prosecution and incarceration costs are avoided. If they do re-offend, the costs are not avoided, but are shifted into the future.
  2. Reduced dependence on social services and increased positive economic contribution. Graduates who resume productive careers or become employed contribute to the economy, pay taxes, and reduce their reliance on social assistance or other social services.
  3. Quality of life. General benefits exist to graduates and their family in terms of quality of life by addressing their addictions and criminal behaviour (Department of Justice Canada, 2009).

For purposes of this report, the focus is on avoided or delayed prosecution and incarceration costs. A determination of the potential benefits to the broader system or the individual is beyond the scope of this evaluation.

The recidivism study conducted by Justice Canada found no statistically significant differences between the recidivism rates for DTC participants and the rates for non-participants, although rates of re-offending were significantly lower among DTC graduates when compared to the comparison group and those who were terminated from the program. For the purpose of determining efficiency and economy, all DTC participants were included in the analysis as that more accurately presents the true costs and benefits of the DTCs. Because the recidivism study did not find a statistically significant difference between DTC participants and the comparison group, the analysis for cost effectiveness focuses instead on the end points of the scale — in other words, it assumes either no recidivism or 100% recidivism.

Several potential cost scenarios are presented in Table 17. The cost scenarios assume the same number of offenders for the traditional criminal justice system and the DTCs. The cost of the traditional criminal justice system includes the cost of court processing and the cost related to different sentences (e.g., incarceration, probation). As sentencing patterns are not available for either the DTC or the comparison groups, the analysis assumes that all offenders receive the same sentence in each scenario.

When incarceration is involved for offenders in the traditional criminal justice system — whether it is federal or provincial incarceration — the costs are substantially higher than for offenders attending DTCs.

These results indicate that DTCs offer substantial cost savings to government compared to the alternative of incarceration.

However, the results also demonstrate that the efficiency and economy of DTCs are dependent on sentencing patterns. As shown in Table 17, if offenders received only probation, the DTC costs are substantially more. However, this cost scenario only includes the costs attributed to offender supervision. The cost estimates for probation do not include the costs of treatment, should that be a condition of probation.

The recidivism study shows that graduates have a significantly lower recidivism rate than the comparison group. Based on this finding, DTCs will increase their cost effectiveness over the long term as they improve their graduation rates. In addition, the recidivism study results indicate that DTC participants (graduates and non-completers) tend to have less drug offences when they re-offend than the combined comparison group: 30% of their subsequence offences are drug offences compared to 59% of the comparison group. DTC participants tended to commit non-drug offences. The type of other offences and the sentencing patterns were not captured in the study and would have provided useful information for better projecting potential DTC savings to the criminal justice system.

As mentioned in the 2009 evaluation report, more information on costs and longer-term benefits of DTCs are needed to assess their relative cost advantages to the traditional criminal justice approach. However, the available data suggest that DTCs may offer potential cost savings. A more complete understanding of the potential cost savings and benefits of DTCs, particularly in comparison to the traditional criminal justice system, requires information on DTC participants and a comparison group of longer-term outcomes such as employment and recidivism, other potential costs, such as social assistance and health care, and sentencing patterns should they re-offend.

Table 17: Cost Effectiveness over Two Years (Calculations based on average annual number of participants for each DTC)
  Vancouver Regina
Average annual number of participants (2009–10 to 2013–14) 65 41
Table 17a: Cost Effectiveness over Two Years (Calculations based on average annual number of participants for each DTC) - No Recidivism - Provincial Corrections
  Traditional: One-year sentence DTC: One year in DTC
Vancouver Provincial corrections $4,363,905 $1,941,494
Vancouver Probation $320,580
Regina Provincial corrections $2,348,562 $1,269,000
Regina Provincial Probation $202,212
Table 17b: Cost Effectiveness over Two Years (Calculations based on average annual number of participants for each DTC) - No Recidivism - Federal Corrections
  Traditional: Two-year sentence DTC: One year in DTC
Vancouver Federal corrections $15,477,020 $1,941,494
Vancouver Federal Probation $476,580
Regina Federal corrections $9,762,428 $1,269,000
Regina Federal Probation $300,612
Table 17c: Cost Effectiveness over Two Years (Calculations based on average annual number of participants for each DTC) - Recidivism: Re-offend in year 2
Year 2 subsequent sentence Traditional: (after one year in provincial custody) Traditional: (after one year probation) DTC: (after one year in DTC)
Vancouver Federal corrections $12,184,705 $8,141,380 $9,762,294
Vancouver Provincial corrections $8,727,810 $4,684,485 $6,305,399
Vancouver Probation $4,684,485 $641,160 $2,262,074
Regina Federal corrections $7,281,682 $5,135,332 $6,202,120
Regina Provincial corrections $4,697,124 $2,550,774 $3,617,562
Regina Probation $2,550,774 $404,424 $1,471,212

Sources: DTCFP funding applications; DTCIS and Vancouver DTC data; Public Safety Canada, Corrections and Conditional Release 2013; Statistics Canada supplied data on provincial average daily inmate cost in current dollars, 2011–12.

The literature generally supports the finding that the DTCs offer economic benefits. A study by Aos, Miller, and Drake (2006) found that the benefits to victims and taxpayers from the reductions in crime associated with adult DTCs outweigh the costs per participant. Other cost-benefit analyses have also found positive net economic benefits (e.g., benefits minus costs) (Fomby & Rangaprasad, 2002; Institute of Applied Research, 2004; Logan et al., 2004). Although a Bayesian analysis conducted by Downey and Roman (2010) found less likelihood (only 14%) that the benefits of DTCs will exceed costs, the same study found that, in some cases, DTCs have the potential to produce very large aggregate social gains (as much as $3.4 million).

4.5. Alternatives

There are essentially four primary alternatives for handling offenders who have substance abuse issues. They are:

It can be difficult to choose from one of these four options. Numerous studies of various types of adult corrections programs aimed at drug-addicted offenders have found that drug courts achieve reductions in recidivism, and are more effective in reducing recidivism than the conventional justice system and other types of programs for addicted offenders, such as in-prison therapeutic communities, cognitive-behavioural drug treatment, drug treatment in jail, and “boot camps” (Aos et al., 2006; Downey & Roman, 2010; Leticia Gutierrez & Bourgon, 2009; Koehler et al., 2013; Latimer et al., 2006; Mitchell et al., 2012, 2006; Shaffer, 2006, 2011). Footnote 37 Footnote 38 Footnote 39 The latter two options — treatment in prison and treatment under parole — occur during or after a period of incarceration. As Section 4.4 demonstrated, incarceration is substantially more expensive than DTCs when recidivism rates between the two groups of offenders are similar. The expense of the traditional system would be even greater when DTC recidivism rates are lower, as many studies cited above have found.

A recent study compared effectiveness of DTCs to probation and found that recidivism of DTC graduates was far lower than the probation group, but that those who did not complete the DTC (terminated or withdrew) had an almost identical re-arrest rate as the probation group (Fulkerson, 2012). Another study of “seamless” probation that is collocated with treatment found less recidivism, but it was insufficient to make the program cost effective (Alemi et al., 2006). However, there is a more recent type of probation that has received attention and shown early promise called “swift and certain” sanctions.

The most high-profile example of “swift and certain” sanctions is the Hawaii Opportunity Probation with Enforcement (HOPE) project. The HOPE project emphasizes swift and certain sanctions when conditions of probation are violated (Hawken & Kleiman, 2009). While probationers once learned of drug tests a month in advance, they are now notified through a daily telephone call whether they will be tested before 2 p.m. on that day. If they do not appear for the test or fail it, results are immediate and include arrest and sentencing to a short jail term of several days, which can be served on the weekend if the probationer is employed. The length of sentence increases with additional violations. Probationers are not mandated into drug treatment unless they request it or they continue to have no-shows or fail drug tests. They do not have to appear in court unless they have violated their conditions of probation. In these ways, the HOPE project expects to use fewer resources than a DTC. The HOPE project is still rather new, but after one year results were positive. Compared to a control group of probationers, HOPE participants were 55% less likely to re-offend, 72% less likely to use drugs, and 53% less likely to have their probation revoked (National Institute of Justice, 2012). Results from a larger evaluation of the HOPE model that involves four other jurisdictions are expected in 2015 (National Institute of Justice, 2012).

Another newer approach in the literature is reentry drug courts, which are sometimes termed the “next generation” drug courts. Reentry drug courts are not a replacement for DTCs but are an extension of the DTC model to drug-addicted offenders who are leaving correctional facilities and reentering the community. These courts explicitly use the “10 Key Components” model of DTCs. Participants receive the usual DTC interventions and services as well as additional services to assist with reentry (NDCRC, 2012). A recent evaluation of reentry courts found that participants had lower re-arrest rates (although not statistically significant) than a comparison group, but they did have significantly lower reconviction rates (Hamilton, 2010).

Other specialized courts can also address addictions, such as Aboriginal health to wellness courts and First Nations courts (Bennett, 2010; New Brunswick Department of Justice and Consumer Affairs, 2010).

These courts operate similarly to other problem-solving courts, but they also include cultural and traditional treatment services. Early results indicate some success in reducing recidivism (Hornick, Kluz, & Bertrand, 2011).

As noted in one recent study, DTCs are not the only model for addressing the link between addictions and crime. There are other options for providing drug treatment through the criminal justice system (during, after or in lieu of incarceration). However, these options are often not studied together so that differences in their efficacy with respect to types of drug addictions, demographics of participants, methods of treatment, or types of supervision are explored (Green, Juppe, Pilgrim, & Powell, 2007).