Problem

Problematic Behavior Or Activity

In Multnomah County, a large number of substance-dependent persons with associated mental health conditions revolve through the criminal justice system.

Impact On The Community

The quality of life for these offenders, their families, and their communities is diminished as a result of their drug dependence and frequent criminal behavior. The cost to the county, state, and taxpayers is significant, given that incarceration is the most expensive sentencing option.

Solution

Program Description

Multnomah County’s Success Through Accountability, Restitution, and Treatment (START) Court was created in 2010 to provide comprehensive programming for people who have committed property crimes and struggling with addiction and associated mental health conditions. The program’s overarching purpose is to reduce recidivism and thus increase public safety by addressing addiction issues, increasing pro-social behavior, and holding each individual accountable. The program lasts a minimum of 12 months and provides intensive probation supervision, treatment, and accountability with a collaborative team approach using evidence-based practices. START Court targets high-risk, high-need substance-dependent persons who otherwise could have been sentenced to prison.

Team members include the circuit court, the district attorney, the defense bar, the Multnomah County Department of Community Justice (DCJ), and the treatment providers InAct/Volunteers of America. The project partners support the widely recognized 10 Key Components of Drug Courts as follows:

1. Integrated treatment and justice system case processing: The primary treatment provider, InAct, attends every court hearing and integrates the court’s directions into treatment and case plans.

2. Ensure public safety and protect due process: Sanctions and incentives, outlined below, are clarified before being imposed and are based on evidence-based practices.

3. Early and prompt placement: Many START cases require judicial settlement conferences or other legal action. All START clients are repeat property offenders who score as high risk to recidivate, high risk in the alcohol/drug section of the Level of Service/Case Management Inventory (LS/CMI), and are available for supervision. Once sentenced to START, clients are seen by DCJ personnel within two working days and by InAct within one week.

4. Continuum of treatment and rehabilitation: Intake and assessment using American Society of Addiction Medicine (ASAM) criteria occurs within two weeks for each new START client. Clients requiring detoxification are sent to the Hooper Detoxification Stabilization Center. Most clients enter intensive outpatient treatment at InAct; clients receiving Medication-Assisted Treatment (MAT) continue treatment with the agency CODA. Clients who require residential care have access to multiple facilities in the area.

5. Frequent alcohol/drug testing: All START clients are randomly tested at least twice weekly. Clients are required to call a recorded urinalysis (UA) test line daily and must provide a UA if their assigned number is announced for that day. All no-shows, positives (non-residual), and no-samples are addressed in court within two business days.

6. Coordinated compliance strategy: Final court decisions and actions always rest with the judge. Within this constraint, START outlines accountabilities in advance to ensure that clients are responsible for their choices and behavior. The START team meets two hours before every START court session to review each client on the day’s docket, discussing treatment, supervision, and overall progress in the program prior to imposing a sanction. Sanctions include sitting an extra day in court, appearing before the judge more often, more frequent drug testing, community service, and jail. Sanctioning is based on evidence-based practices of proximal and distal goals. Incentives are also available, including praise from the bench, public applause, less frequent appearances before the judge, placement at the head of the docket, and small gift certificates or contingency awards for attaining treatment and/or sobriety milestones.

7. Ongoing judicial/participant interaction: Clients are in court every one to six weeks; each schedule is determined by program phase, treatment progress, sobriety, and pro-social behavior.

8. Measure goals and gauge effectiveness: DCJ monitors all data involving enrollment, type of discharge, and recidivism. InAct/VOA also monitors treatment outcomes and critical life-stability factors.

9. Continuing education: START staff participate in continuing education, local treatment court hearings, and annual national drug court conferences, They also travel to other drug courts to observe and replicate components of successful programs.

10. Collaboration: In addition to the core project partners, START has relationships with many agencies, including the sheriff’s office, Hooper Detox, residential programs, domestic abuse survivors resources, the Veterans Administration, and the Salvation Army.

Based On Research

• Research Update on Adult Drug Courts, NADCP, 2010

• Evidence-Based Sentencing for Drug Offenders: An Analysis of Prognostic Risks and Criminogenic Needs, Chapman Journal of Criminal Justice, 2009

Funding

START is funded by a number of grants and funding sources:

• A $2,246,400 grant from the Oregon Criminal Justice Commission

• A $325,000 grant for parenting services from the federal Substance Abuse and Mental Health Services Administration (for three years beginning in September 2014 and shared with another local drug court)

• A $200,000 federal Bureau of Justice Assistance alumni grant (for two years beginning in September 2014).

• Each agency also provides support with FTEs. The Multnomah County Department of Community Justice provides significant resources, including in-kind, training expenses, and more.

Outcome

Program Impact

START currently has 180 participants assigned to the program. From March 2015 through February 2016, 36 people graduated.

Critical Success Factors

• Follow NADCP’s Adult Drug Court Best Practice Standards and the 10 Key Components of Drug Courts.

• Engage in ongoing training on evidence-based practices.

• Focus on evidence-based sanctioning (being able to identify proximal/distal goals and appropriate responses).

• Be sure to have ongoing, responsive communication with all team members on a daily basis.

• Support of a committed judge who is dedicated to the therapeutic model of drug court.

Lessons Learned

• Frequent and truly random drug tests are important, including for designer drugs. START modified its drug testing to be more truly random and less predictable for clients, to promote accountability and provide them with the support they need while in the beginning stages of lifelong recovery.

• Medication Assisted Treatment (MAT) is an evidence-based practice and an important option. Because of insurance issues, MAT was not accessible to many participants during the early stages of the program. START now has access to and a close relationship with a MAT provider for various medications.

Additional Resources

Multnomah County START Court Overview

Multnomah County Treatment Courts Overview