Drug Treatment Court Funding Program Evaluation
5. Conclusions and Recommendations
This final section of the report presents conclusions based on the findings described in the previous sections. The information is structured along the main evaluation issues and questions.
The DTCFP aligns with federal priorities, as evidenced by long-standing federal commitments to address crime and drug use in Canada, in particular through the National Anti-Drug Strategy of which the DTCFP is part. The federal government has indicated that DTCs remain an integral component of its criminal justice strategy by providing an exemption for attending DTCs under its mandatory minimum sentencing provisions in the Criminal Code and the CDSA. Although still holding offenders accountable for their actions, the exemption allows courts to delay sentencing drug-addicted offenders while they attend provincially approved and court-supervised treatment programs — including DTCs. The use of contribution funding through the DTCFP also aligns with federal roles and responsibilities in the area of criminal justice, which is a shared responsibility with provincial/territorial governments. By providing funding and not dictating or supervising DTC operations, the federal government respects the provincial/territorial authority for the administration of justice.
The DTCs address a continuing need. Research indicates a strong connection between criminal behaviour and the use and abuse of drugs and alcohol. To respond to the revolving door of people with addictions into the criminal justice system, specialized therapeutic DTCs were developed in the late 1980s and have flourished since then. The growth of DTCs is driven in large part because of numerous studies that show positive results in reducing recidivism and the potential cost savings. In addition, the DTCFP remains relevant as without its support, DTC stakeholders believe that DTCs in Canada would certainly not expand and may even contract in terms of numbers of courts, capacity for admitting clients, and/or the services offered.
5.2. Design and Implementation
Since the last evaluation, the DTCFP focused much of its efforts on building stronger relationships with provincial and territorial governments. The 2009 evaluation recommended that provincial or territorial governments be funding recipients rather than NGOs, given the challenges that NGOs had experienced. NGOs remain funding recipients in some locations (Toronto, Ottawa, Winnipeg), but Alberta Justice and the Attorney General is now the funding recipient for Edmonton, and the next funding agreement for Winnipeg will be with Manitoba Justice. In addition, the DTCFP officials have established connections with all provincial and territorial jurisdictions. An example of this close working relationship is the Ad Hoc F/P/T Working Group on DTC Efficiencies and Resource Allocations. This working group is currently considering appropriate federal/ provincial/territorial oversight of federally funded DTCs and how to distribute the DTCFP budget across jurisdictions interested in receiving federal funding for DTCs.
The DTCFP has also worked to maintain close contacts and improve communications among DTC stakeholders, which was another recommendation from the 2009 evaluation. The DTCFP has effectively responded by resuming regular monthly DTC directors’ conference calls, which serve as a forum for information sharing and peer discussions. The opportunities to have face-to-face encounters through DTCFP site visits or meetings of the DTCs at the biannual CADTCP conferences have become more limited due to travel restrictions. The evaluation found evidence of the continued need to work with DTCs to share lessons learned and best practices.
It is recommended that the DTCFP continue to work collaboratively with provinces and territories to identify DTC’s unique costs and to consider the provincial/territorial role in the DTC funding agreements.
All new three-year funding agreements will be with provinces and territories and will identify the unique DTC costs which are eligible for DTCFP funding. In addition, these agreements identify the roles of the signatory province and/or territory. These new agreements took effect April 1, 2015.
The evaluation compared many of the DTC processes to identified best practices in the DTC literature and found, with few exceptions, that the DTCs are following these approaches.
All of the DTCs have multidisciplinary teams, regular meetings (pre-court and court) for sharing information, strong collaboration with judges, and generally consult with treatment professionals prior to making decisions concerning DTC participants. Some of the DTCs vary from best practices as participants may not always appear before the same judge. Another potential area for improvement is clarifying roles and responsibilities of team members. Although it is recognized that allowing variation in DTC structures is important to enable the courts to respond to local needs, DTC stakeholders thought written policies and procedures that outlined roles and responsibilities would be helpful. In addition, some variation in roles was questioned, such as whether counsellors should perform UDTs or whether that compromised their relationships with their clients.
In terms of admissions and reach, the evaluation found that the eligibility criteria and process of admissions met best practices in terms of being objective and evidence based. However, the issue related to reaching its target groups persists, as it continues to be difficult to reach its target groups of youth, Aboriginal men and women, and other historically disadvantaged groups. Although currently DTCs are still primarily admitting high-risk clients (which is also a best practice), concerns were expressed that lower-risk clients are applying. The inclusion of these offenders would mean that individuals with little prior criminal history are entering the DTC. DTCs may want to monitor whether more lower-risk participants are being admitted.
The treatment component of the DTC also generally follows best practices in the DTC literature, although there is some room for improvement. The RNR model is a well-tested, evidence-based approach for aligning DTC treatment with participant needs. The evaluation found adherence among the DTCs of at least one or two of its core principles. In particular, most DTCs use standardized, validated risk assessment tools and the results of the assessments are factored in treatment plans. Given that studies show that full adherence to the three core principles of the model results in the greatest reduction in recidivism, the DTCs may wish to consider how to make greater use of the RNR model, which could include training DTC staff in RNR principles.
The evaluation found a robust continuum of care that relied on a variety of treatment options, which aligns with best practices approaches. Meeting the unique needs of some of the DTC target populations, such as Aboriginal people and women, remains an issue — particularly in terms of attracting them into the program and retaining them once they have entered. That being said, some DTCs offer specialized programming to address the unique needs of these groups. The evaluation also found that the continuum of care largely ends once the recipient leaves the program, although DTCs encourage participants to keep in touch. A few DTCs offer programming post participation, such as alumni groups or a formal aftercare program. Given these findings, DTCs may want to review their programming as the literature on DTCs identifies continuing care as a best practice.
Another gap that remains since the last evaluation is housing. The DTCFP followed recommendations made in the 2009 evaluation and worked with Human Resources and Skills Development Canada to fund two pilot housing projects. Evaluations of both projects showed promising results in terms of the retention of DTC participants; however, the issue of sustainable funding for DTC housing remains.
In accordance with best practices, the court component provides structure to the DTC program, and the evaluation results indicate that the DTC court process is generally working well. DTC stakeholders approved of the intensity (regularity and number of appearances) and appropriateness (of bail conditions) of the court process. The one issue raised by DTC stakeholders and case study participants related to the use of sanctions. Although sanctions were considered a useful component of the court process and helped participants stay “on track”, there is the perception that they are not always consistently applied. As studies have shown that “swift and certain” sanctions are the most effective, this is an area of potential improvement for the DTCs.
It is recommended that the DTCFP work with the provincial/territorial partners to encourage clarification of roles and responsibilities of DTC team members.
All new three-year funding agreements will identify the roles of the signatory province and/or territory. In addition, through the Permanent FPT Working Group, the DTCFP team will continue to work with provincial/territorial partners to encourage clarification of roles and responsibilities of DTC team members.
It is recommended that the DTCFP examine ways in which it can work with the provincial/ territorial partners to share lessons learned and best practices among the DTCs, and more particularly, best practices for court and treatment components.
More specifically, it is recommended that the DTCFP work with the DTCs to strengthen the adherence to the eligibility criteria, ensuring they serve the optimal target population most in need of the program and at greatest risk of relapse and recidivism. Furthermore, DTCs should appropriately match their services to the needs and risk level of their client population.
The DTCFP team will continue to work with provinces and territories through the Permanent FPT Working Group with a view to sharing lessons learned and best practices. This will include assessment approaches in regards to determining DTC eligibility.
It is recommended that the DTCFP work collaboratively with provincial/territorial partners to discuss issues affecting DTC effectiveness, including housing.
The DTCFP team will continue to work with provinces and territories through the Permanent FPT Working Group to identify solutions for issues affecting DTC effectiveness. In addition, where appropriate, the DTCFP team will assist provinces and territories in obtaining assistance from other federal departments in order to address issues affecting DTCs.
5.3. Performance Measurement
The 2009 evaluation noted issues with the consistency and completeness of DTCIS data. The DTCIS data was more complete than was evidenced in 2009, allowing the present evaluation to include analyses of the data. However, the DTCFP still needs to streamline the DTCIS so that it will support evaluations in the future. From a case management perspective, the evaluation found that the DTCIS could improve in terms of capturing necessary qualitative information for case management, and providing useful statistics for case management and/or monitoring the operations of the DTCs.
It is recommended that the DTCFP work with the Evaluation Division and provincial/ territorial partners to determine ways to improve the DTCIS quality and consistency of data in order to support the next evaluation and departmental reporting requirements.
All new three-year funding agreements will require provinces and territories to provide the data using the revised DTCIS to allow for consistent, national data collection. The revised DTCIS was developed in consultation with the Evaluation Division and provincial/territorial partners.
DTCs have challenging target populations that are drug addicted, generally at high risk of re-offending, have multiple other issues (e.g., poverty, mental illness, low education levels), and often few supports (e.g., lack of family connections, negative peer associations). This context is important when considering the performance of the DTCs in achieving their outcomes.
The evaluation results indicate that even with these challenges, the DTCs are showing promising results in several areas.
Retention and graduation: The DTCs have a retention rate of 36% and a graduation rate of 27%, which are similar to the 2009 evaluation results. As retention and graduation have been shown in the literature to have a positive effect on recidivism, and therefore the cost effectiveness of DTCs, determining how best to improve retention and graduation remains a key concern for the DTCs.
Reducing drug use: The evaluation results show that both graduates and non-completers have reduced drug use during the program. The reduction in dirty UDTs and increase in clean UDTs occurred for both groups quickly (after only three months). Graduates showed greater reductions in drug use than non-completers, but the results show substantial reductions in dirty tests for both. Even though the study conducted for the evaluation focused on those who had been in the program for 15 months, these results indicate potentially very positive impacts for the DTCs.
Use of community supports and social stability: The available evidence from the survey and case study participants shows that DTCs make participants aware of and refer them to a variety of community supports. Participants also attribute various improvements in their social stability to their involvement with the DTCs. Improvements include better familial relationships, finding employment, and better housing situations.
Reducing criminal involvement: The recidivism study conducted as part of this evaluation compared DTC participants to a comparison group of similar offenders. The study found that post-program rates of re-offending were significantly lower among DTC graduates than non-completers or the comparison group. The difference in the rates of recidivism between the DTC participants (i.e., graduates as well as non-completers) and the comparison group was not statistically significant. The study also found that the DTC participants who re-offended had less drug offences than the comparison group. Thus, when the type of offence is considered, the recidivism rates could show that the DTCs reduce recidivism for drug-related. Although more study is needed, the results for graduates are very positive.
5.5. Efficiency and Economy
The evaluation compared the costs of the DTCs to incarceration (provincial or federal) and probation. Due to the limited availability of certain information that would assist in the analysis (e.g., sentencing information, global costs of the DTCs), the analysis requires making several assumptions about DTCs and the traditional system. It presented several cost scenarios for the two DTCs that have the most complete cost information (Vancouver and Regina). The cost savings, depending on the sentence and what proportion of the DTC participants re-offend, ranges from 20% up to 88% if incarceration is assumed. However, if offenders in the traditional system receive a probationary sentence, then the DTCs cost substantially more. The analysis aligns with other studies that indicate the potential for substantial cost savings for DTCs. In addition, the analysis does not consider the potential benefits of the DTCs, such as reduced demands on social services and improved quality of life. It is estimated that the social cost of illegal drug used to be $8.2 billion for one year. This estimation includes both direct (i.e., the burden on health care and other services.) and indirect costs (i.e., disability, ill health).
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