BREAKING THE CYCLE OF DRUGS AND CRIME: FINDINGS FROM THE BIRMINGHAM BTC DEMONSTRATION

BREAKING THE CYCLE OF DRUGS AND CRIME: FINDINGS FROM THE BIRMINGHAM BTC DEMONSTRATION

ADELE HARREEL" The Urban Institute

OJMARRH MITCHELL The University of Maryland

ALEXA HIRST The Urban Institute

DOUGLAS MARLOWE Treatment Research Institute

JEFFREY MERRILL Robert Wood Johnson Medical Center

Research Summary: We compared 137 felony defendants arrested before the implementation of Breaking the Cycle, a pretrial intervention with felony defendants that included drug testing, supervision, and drug treatment as needed, to 245 BTC participants. We found significant lower rates of arrest and self-reported drug use and crime among B T C participants during the next year.

Policy Implications: Systematic intervention aimed at all drug-involved felony defendants, not just selected defendants, is effective, but may encounter substantial challenges in achieving collaboration across criminal justice agencies, services providers, and levelshranches of government.

KEYWORDS: Drug Use, Drug Testing, Drug Treatment, Adult Offend- ers, Graduated Sanctions

Lessons from over a decade of research on drug use among offenders points to several key principles about effective interventions for reducing crime related to drug abuse that seem to transcend the particular justice

* This project was funded by NIJ collaborative agreement number 97-IJ-CX-0013 with funds from the Office of National Drug Control Policy. The views expressed are those of the author(s) and not necessarily those of the National Institute of Justice or the Office of National Drug Control Policy.

VOLUME 1 NUMBER 2 2002 PP 189-216

190 HARRELL ET AL.

agencies and settings in which programs operate. One is that placing offenders who abuse drugs in community-based treatment can reduce their drug use and subsequent risk of arrest (Anglin et al., 1999). A second is that coercion, in the form of close monitoring and graduated sanctions for continued drug use, will reduce drug use among some offenders (Har- re11 et al., 1998). A third is combining treatment, monitoring, and sanctions produces benefits (Belenko, 1999; Falkin, 1993; Petersilia, 1998). However, it has not proved easy to put these principles into practice. Strategies for maintaining ongoing and effective collaboration between treatment agencies and criminal justice agencies and among criminal justice agencies responsible for offenders from arrest through final release have proved elusive.

Breaking the Cycle (BTC) is a multisite demonstration program funded by the Office of National Drug Control Policy and the National Institute of Justice, designed to test the feasibility and impact of a coordinated effort to respond to drug use with consistent and effective intervention. Breaking the Cycle involves ongoing collaboration among the jail, the prosecutors, the judges, the Treatment Alternatives to Street Crime (TAX) agency, treatment providers, and probation departments, each of which has different roles, mandates, resources, and authority. The goal of the collaboration is early intervention and continued services for all drug- involved offenders throughout the duration of their involvement with the criminal justice system. The envisioned collaboration is a significant depar- ture from traditional criminal justice systems in which jails manage book- ings, prosecutors and courts manage cases, and community corrections agencies focus on offender supervision and sometimes treatment.

This paper presents findings from the process and impact evaluation of the Birmingham, Alabama BTC program, the first of three programs funded to serve adult offenders. Based on the principles outlined above, program planners identified four core BTC components: (1) early screening to identify drug users and assign them to appropriate interventions upon entry into the criminal justice system; (2) required participation in drug interventions, including case management, drug testing, and treatment as needed; (3) use of graduated sanctions in response to drug test failures and other BTC requirements; and (4) expanded judicial monitoring of compliance with requirements. Although BTC hoped to provide interventions from arrest until final release from supervision (i.e., probation or post-incarceration supervision), regardless of whether the offender remained in custody or was released to the community (see Figure l) , BTC services in Birmingham were limited to defendants on pretrial release - the section of the vision outlined by the dark dotted line in Figure 1.

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192 HARRELL ET AL.

ORIGINS OF THE BTC INTERVENTION STRATEGY

BTC’s strategy for linking offenders to treatment builds on the experi- ence and practices of earlier criminal justice drug intervention programs. Three of the most influential are TASC, drug courts, and programs that use graduated sanctions to enforce offender compliance with drug abstinence requirements. These programs offer a patchwork of potentially effective interventions, but access to them has been limited by narrow eligibility requirements, shortage of resources, and the fundamental difficulty of coordinating services for large numbers of drug-involved individuals as they move through the criminal justice system. Perhaps more importantly, these programs have not been systemically incorporated into the criminal justice system as a part of a comprehensive strategy to deal with all offenders who use drugs throughout the period that they are in the system. BTC incorporates case management and treatment referral networks

based on the TASC model. TASC programs offer a network of specialists who find treatment placements for court-referred clients and monitor their progress. The types of defendants eligible for referral to TASC vary by jurisdiction, but may include pretrial defendants (before plea and after plea, but before sentencing), those accepted into specific diversion programs, and those sentenced to probation. TASC providers and treatment agencies may use drug testing to assist clients in confronting their drug problems and to provide information on continued drug use for treatment guidance.

In an extensive national evaluation, researchers found significant reductions in self-reported drug use associated with TASC participation, but no reductions in subsequent arrests or probation violations (Anglin et al., 1999). The analysis also revealed that many offenders referred to TASC progranis never reported to the agency. Many others who enrolled in TASC dropped out of treatment prematurely, often without being subject to consequences because justice agencies failed to monitor compliance with treatment referrals and drug test results. These findings suggest that although TASC programs are frequently effective in linking with treatment programs and decreasing substance use for those who choose to participate, their effectiveness may increase if drug-involved offenders were compelled to remain in these treatment programs. BTC was designed to remedy the problem of treatment retention by increasing offender accountability through judicial monitoring and drug testing, in much the same manner as in drug courts. BTC adopted the practice of judicial review and monitoring of defen-

dant treatment and progress toward abstinence from drug courts. Drug court judges frequently review defendants’ treatment compliance and drug test results and offer praise, warnings, or sanctions based on the results.

FINDINGS FROM THE BIRMINGHAM BTC 193

Most, but not all, evaluations using experimental or strong quasi-experimental designs have found that drug court participants are less likely to be rearrested following program participation than are otherwise comparable offenders not enrolled in drug court (Bedrick and Skolnick, 1999; Finigan, 1998; Goldkamp and Weiland, 1993; Gottfredson and Exum, 2000; Jame- son and Peterson, 1995; Office of Justice Programs, 1998; Peters and Mur- rin, 1998; Smith et al., 1991). However, whether these positive findings can be generalized to all defendants facing drug charges is unclear, because drug court participation is voluntary and limited to defendants who meet varying eligibility requirements. Well-designed evaluations that did not find positive effects (e.g., Deschenes et al., 1995; Granfield and Eby, 1997) note that these courts experienced significant implementation problems. For example, Deschenes et al. (1995) reported that the drug court participants in their study actually had fewer contacts with justice personnel and fewer alcohol and drug tests administered than did the control group.

The BTC emphasis on the use of graduated sanctions builds on growing evidence that timely and consistent use of well-understood penalties for noncompliance contributes to the likelihood that offenders will comply with requirements to attend treatment and remain drug-free. The District of Columbia Superior Court Graduated Sanctions Program produced significant reductions in drug use during pretrial release and in criminal activity in the year after sentencing among drug felony defendants subject to graduated sanctions for drug test failures (Harrell et al., 1998). Features believed to be key in producing the observed reduction in recidivism included the fact that defendants signed contracts in advance acknowledg- ing the testing rules and the penalties for test failures, the fact that sanctions were typically imposed within a week, and consistency in applying penalties was extremely high. Other evidence comes from Falkin (1993), who found that community-based treatment combined with urinalysis, court monitoring, and judicial sanctions had higher rates of success than did treatment alone. Tn contrast, system-wide drug testing of offenders in community corrections without systematic monitoring, sanctions, or treatment in another program was found to have no impact on recidivism (Har- re11 and Cavanagh, 1994).

The BTC demonstration tests the hypothesis that combining these components into a comprehensive system-wide intervention will reduce drug use and crime.

BTC IMPLEMENTATION IN BIRMINGHAM

Studying how system reform can be achieved and what policymakers and agencies need to know about drug intervention programming was a major goal of this research and provides several important lessons for

194 HARRELL ET AL.

jurisdictions planning such initiatives.1 The first site, Birmingham, Ala- bama, began delivering services in 1998. At the start of the project, Bir- mingham, like many urban jurisdictions, faced overcrowded jails, large court and probation caseloads, data systems that did not facilitate commu- nication among criminal justice agencies, and a shortage of drug treatment funds. The organizational challenges in Birmingham were also similar to those in other jurisdictions and included the need to implement collaboration across branches of government (the judiciary and executive), between agencies with distinctly different mandates and funding streams, and between local and state agencies. The likelihood of successful implementation depends in large part on recognition of, and planning for, ways to address these challenges.

In the case of BTC in Birmingham, organizational barriers to collaboration proved particularly difficult. The process evaluation produced two major findings on implementing system-wide drug intervention programming. The first is that a centralized process must be set up and supported by all partner agencies for negotiating changes that affect multiple agencies. It took the program over a year to establish a working Policy Board to manage the coordination, but by the end of the demonstration period, real interagency collaboration was underway. It proved particularly difficult to engage the Probation Department, a state agency with headquar- ters in the state capital, in operational changes to meet the needs of a local program and probation officers assigned to Jefferson County were reluc- tant to get involved in case management and drug treatment, which had been traditionally a TASC responsibility. Collaboration with the state prison system was not attempted, and BTC records on treatment and treatment needs did not follow offenders sentenced to prison, again due to the difficulties of establishing working relationships between local and state agencies.

The second major finding was that when dealing with large numbers of offenders, automated information systems for timely information exchange must be set up to enable effective cross-agency collaboration. One of the most difficult problems in implementing BTC proved to be the exchange of information among the jail, the courts, and TASC. The jail had an automated data system but only allowed TASC and the judiciary to access aggregate reporting functions, restricting full access to the data system to jail staff. Reasons given included confidentiality concerns, incom- patible technologies, and need for additional hardware and software. As a

1. For a more detailed discussion of the implementation of BTC in Birmingham, see Harrell et al. (2000), and for a discussion of BTC’s effects on other outcomes see Harrell, Hirst, Mitchell, Marlowe, & Merrill (2001), available through the Urban Insti- tute’s website: www.urban.org.


result, neither the court nor TASC knew which defendants were in custody without submitting a query on the status of each individual every single day; an impossible undertaking in the face of very large caseloads of active clients, which averaged more than 2,000 per month. This made it impossible to determine efficiently which defendants were due to report to TASC and which defendants were missing appointments because they had been jailed. In Birmingham, the goal of linking the data systems was never attained, and exchange of information remained difficult and time-consuming. All of the adult BTC sites have found information exchange to be crucial and a demanding challenge.

The case study also points to the need for careful advance planning of the demands of specific changes and the capacity of partner agencies to respond to these demands. Overcrowding in the jail proved to be so severe that early efforts to screen clients for drug use and provide treatment in jail failed. The lack of jail space, coupled with problems engaging the state corrections agencies, meant that BTC was limited to services to felony defendants on pretrial release. Instead, eligible defendants (Jefferson County residents arrested on felony charges) were required, as a condition of their bond, to report for drug screening within 24 hours of their release from jail. Offenders who were detained throughout the pretrial phase were not offered BTC services. However, because of the lengthy period between case filing and sentencing in Birmingham (over a year on average), BTC was able to provide intervention over an extended period of time to most participants.

One unanticipated problem was judicial reluctance to develop and use graduated sanctions in a way that was consistent with the BTC model. Although judges did sanction defendants for problem behavior, these responses usually consisted of short-term “shock” incarceration, during which defendants did not know the ultimate duration of their incarceration or if other conditions would be imposed. The judges intended the threat of jail to deter further violations, and they believed that uncertainty about the circumstances of the sanction would heighten its potency. This sharply contrasted with the BTC model for graduated judicial sanctioning, in which specific behaviors would be tied to specific, known sanctions.

Resistance to BTC procedures stemmed from several considerations. Some judges reported that review hearings were too time-consuming. Others indicated reluctance to participate in collaborative planning meet- ings and were unfamiliar with the sanctioning plan. To some extent, judicial resistance was also grounded in a desire to remain a separate and independent role, and wariness about the therapeutic orientation of BTC. After some struggle, BTC adopted special compliance review hearings presided over by a retired judge for defendants awaiting grand jury review (typically, a five-month wait) and for defendants on probation (used rarely

196 HARRELL ET AL.

for reasons described above). Relatively few cases were referred for review, despite widespread infractions of BTC rules, and fewer still received judicial sanctions.

METHODOLOGY The impact evaluation of BTC in Birmingham was designed to deter-

mine the effect of BTC participation on key outcomes such as recidivism and drug use by comparing a sample of defendants who met BTC eligibility requirements but were arrested in the year before BTC implementation to a sample of BTC participants selected after the program attained full implementation. The samples were interviewed shortly after arrest (baseline) and again nine months later (follow-up) using a version of the Addiction Severity Index (McLellan et al., 1992) modified to include additional questions about illegal activities and participation in drug treatment services. Data on arrests were collected from criminal history records. Data on drug test results, sanctions and infractions data, and participation in on-site drug education groups were collected from the BTC management information system.

The comparison group was selected by inviting arrestees tested for the Drug Use Forecasting (DUF)2 in the Birmingham jail to take part in the study. Between March 13 and July 9, 1997, DUF participants were invited by a research recruiter to consent to be a part of the study and release their DUF drug test results to the research team. Those who agreed (n = 311) signed consent forms and received a $10 stipend by mail. To narrow the sample to drug users, only those who tested positive for at least one drug were retained in the pre-BTC comparison sample (n = 236).

Due to the cancellation of BTC plans for jail screening, the treatment sample was recruited from the defendants ordered to BTC on release. Under BTC, judges ordered defendants charged with felonies to report to TASC within 24 hours, where they were given a drug test and a short, self- administered questionnaire. Those who tested positive, reported drug use, or were charged with drug felonies were admitted to BTC and scheduled for a clinical assessment. The sample was recruited from defendants admitted to BTC. Of the 596 defendants eligible for BTC and contacted between September 8 and November 5 , 1998, 545 agreed to participate in the study (91%) and were sent a payment of $10. However, 171 of them were later found to be ineligible because their charges were dropped or reduced to a misdemeanor, or they lived outside Jefferson County and thus not eligible for BTC services, leaving a final sample of 374. No differences were found between the BTC sample group and the population

2. (ADAM).

DUF was the predecessor to the Arrestee Drug Abuse Monitoring system


BTC of clients (excluding clients in the BTC treatment group) on age, race, gender, highest grade completed, number of prior convictions (misdemeanor or felony), and number of arrests in the five years preceding sample entry. The only significant difference concerned current employment status; the BTC sample group was significantly less likely to be employed full-time in comparison to the overall BTC population (41 Yo vs.

Because the pre-BTC sample was recruited in the jail, arrestees who posted bond immediately after arrest were systemically excluded from the comparison sample, whereas the BTC sample consisted only of arrestees who were released on bond (at the time of arrest or later), eliminating those who were never able to post bond. These differences led to the two samples of offenders having different levels of criminal history; in particular, the pre-BTC sample showed significantly more prior criminal involvement (months incarcerated, prior arrests, probation or parole at the time of arrest), and had more employment problems than did the BTC sample. However, the samples were similar on use of most drugs in the month before arrest, except for marijuana use, which was higher in the BTC sample (Table 1).

48%).

TABLE 1. SAMPLE COMPARISON AT BASELINE ( N = 382)

Pre-BTC Sample BTC Sample Characteristic (n = 137) (n = 24.5)

Male African-American Mean Age in Years Lifetime Mos. Incarcerated Prior Arrests" Self-Reported Offenses, 6 Mos. prior to Baseline On Probation/Parole at Baseline Serious Offender Bothered by Employment Status Days Paid for Working in Past 30-Day Baseline Self-Reported Drug Use Past 30 Days

Cocaine Opiates Marijuana Otherh

82 % 69 Yo 33.19 17.23 7.39

21.08 39% 55% 37 % 4.78

32 % 7 yo

30% 7 YO

78 Yo 66% 31.61** 8.31*** 4.91*** 3.04* ** 1 .r* *

1s Yo *** 13.12***

42%**

31% 6 YO

t lY0 54?'0***

a n = 222 for BTC sample due to missing data. Other drugs included: barbiturates, sedatives/tranquilizers, amphetamines, hallucinogens, and inhalants.

* p < 0.10; **p < 0.05; ***p < 0.01.

Baseline interviews were conducted with 192 in the pre-BTC sample

198 HARRELL ET AL.

(81 %) and all 374 in the BTC sample. The 45-minute interviews were conducted by telephone (1%) or in person (99%). Baseline interviews with the pre-BTC sample took place approximately a month after consent (median = 28 days); 63% took place in jail and 36% in person in the community. All baseline interviews with the BTC sample were conducted in person at TASC within a day of consent. Participants received $10 for the baseline interview.

Follow-up interviews that were similar to the baseline interviews were conducted by phone approximately nine months after the baseline interview (time between interviews mean = 290 days, median = 264 days). One hundred thirty-seven in the pre-BTC sample completed the follow-up interview (71% of those who completed baseline interviews), and 245 in the BTC sample completed the follow-up questionnaire (66% of those interviewed at baseline). Most participants received $10 for completing the follow-up interview, although some hard-to-contact participants received $20. Extensive analysis of potential attrition bias, following the approach of Biglan et al. (1991), found no significant differences between the baseline and follow up samples on demographic characteristics or charge at time of arrest; completion of the follow-up interview and baseline AS1 scores on drug, alcohol, or legal problems; or, the interaction between completion of the follow-up interview and group and the baseline problem scores.

ANALYTIC STRATEGY

The analysis employs two strategies to control for sample differences: (1) incorporating control variables into traditional multivariate models to account for observed sample differences, and (2) using a two-stage estimation procedure to capture the effects of unmeasured sample differences (Heckman, 1978, 1979). The two-stage method is used to assess whether unmeasured variables, related to both sample membership and the outcomes of interest (e.g., recidivism), lead to bias in the estimates of BTC’s effect (Barnow et al., 1980; Smith and Paternoster, 1990; Winship and Mare, 1992). At the first-stage, the likelihood of being in the BTC sample was estimated using predictors believed to differentiate the two groups. The purpose of this first-stage equation is to obtain a correction factor, which in essence is a proxy for unmeasured variables. This correction factor is then included in a second-stage equation as an independent variable along with other variables hypothesized to effect the outcome of interest (see Winship and Mare, 1992; Winship and Morgan, 1999).

The model selected for the first-stage equation was chosen on the basis of its predictive power and parsimony (Table 2). The predictors of group membership were sex (Female = l ) , number of days incarcerated during


the 30 days prior to initial interview, current probation/parole status (Yes = l), number of self-reported crimes committed in the six months prior to the baseline interview, lifetime number of times treated for drug abuse, usual work pattern in the past three years (Full-Time/Student, or Part- Time, Other is the suppressed category), time at current residence (in months), and number of days in the past 30 respondents reported each of the following kinds of problems: drug problems, psychological problems, or employment problems. These variables measure the constructs of criminal history, seriousness of substance abuse problem, medical/psychological problems, ties to the community, and demographic factors. Collectively, these variables produce a pseudo-R2 of .38. The addition of more variables did not significantly improve the model fit to the data.3

TABLE 2. SAMPLE SELECTION MODEL (FIRST-STAGE EQUATION)

Variable Parameter Estimate b/S.E. p-level

Constant 1.40 4.79 0.00 Female 0.34 1.64 0.10 Time at Current Residence -0.01 -1.91 0.06 Full-Time EmploymentiStudent” 0.56 2.42 0.02 Part-Time Employment 0.57 2.21 0.03 Days in Jail, Past 30 Days -0.06 -7.84 0.00 On Parole/Probation at Sample Entry -0.44 -2.45 0.01 Lifetime Number of Prior Drug Treatment Episodes -0.10 -1.48 0.14 Number of Self-Reported Offenses, Past 6 Months -0.01 -2.41 0.02 Days Experiencing Drug Problems, Past 30 Days -0.02 -1.75 0.08 Days Experiencing Psychological Problems, Past 30 Days -0.02 -2.23 0.03 Days Experiencing Employment, Past 30 Days -0.03 -2.90 0.00

Model Fit

Pseudo-R2 0.38

N 382 -2LL 180.93; 11 DF p = 0.0001

a The full-time and part-time employment variables are indicator variables; the suppressed category is all other responses, including “service,” “retired/disability,” “unemployed,” or “in controlled environment.”

Dichotomous drug and recidivism outcome variables were estimated using bivariate probit analysis that simultaneously estimates the first- and second-stage models and the correlation between the two error terms (Rho). This term corrects for selection bias (Smith and Paternoster,

3. Exclusion criteria are used to ensure independence of the two models; the second-stage model excludes some of the variables from the first-stage. The most powerful exclusion restriction was the number of days incarcerated in the 30 days prior to the baseline interview.

200 HARRELL ET AL.

1990:1118).4 Models with counts as dependent variables (e.g., number of arrests) were estimated using probit for the first stage and a separate negative binomial regression for the second stage. All models were estimated in LIMDEP 7.0 (Greene, 1995).

SERVICE DELIVERY IN BIRMINGHAM The services delivered to the sample used in the impact analysis are

described below to provide the necessary context for interpreting the impact findings.

EARLY INTERVENTION

Most BTC cases were screened and placed in BTC shortly after release. Nearly 70% of the sample were assessed within a week of their release, and almost all were drug tested at the time of assessment. Treatment referrals, made for 96% of the clients, were based on clinical assessment of treatment need. Twenty-one percent were referred to urine monitoring only (median enrollment days, 185). Two percent were referred to education groups operated by TASC (median enrollment days of 82 for cogni- tive skills and 32 for drug education). Fifty-seven percent were referred to outpatient treatment, most of whom attended a program located at TASC with frequency dependent on group placement and progress (median enrollment days of 120 for regular outpatient, 73 days for intensive outpatient). Sixteen percent were referred to residential treatment (median enrollment days of 108), and a few were placed in methadone maintenance.

DRUG TESTING

In general, regular drug tests were scheduled and administered for all clients who were not in inpatient treatment. The average number of tests scheduled was 16 per client and ranged from 1 to 51 tests per client. Just over half (53%) of these tests indicated no drug use, 25% showed recent drug use, and 22% were skipped and treated as a test failure by case managers. When classified by the strongest drug identified in any test, the results showed that 11% of the BTC sample members tested positive for heroin (alone or with other drugs) at least once, 43% tested positive for cocaine (alone or with drugs other than heroin), 23% tested positive for marijuana (alone or with drugs other than heroin or cocaine), and the remainder were negative on all of their BTC drug tests.

4. This procedure was also used to assess the potential for attrition bias, by including a second correction term to account for attrition. The results confirm the earlier finding of no significant attrition bias.


GRADUATED SANCTIONS

Most BTC sample members (89%) had at least one recorded infraction, with the number of infractions averaging 11 per client. Most infractions (75%) were recorded for missed or positive drug tests. Other infractions included missed appointments and failure to pay required fees for drug tests or supervision. Each infraction was supposed to elicit an immediate sanction, and sanctions were intended to become gradually more severe as the number of infractions increased. The plan adopted by BTC called for initial sanctions to be administered by BTC case managers (e.g., increased supervision, warning letter), whereas subsequent infractions were supposed to provoke more severe judicial sanctions (e.g., court admonish- ment, brief jail stays). However, BTC case managers did not use structured, graduated sanctions consistently, and clients were not made aware of sanction rules prior to noncompliance.

Nearly all of the clients with infractions received a BTC sanction at some point. However, multiple infractions typically occurred before a sanction was imposed, and sanctions were often far removed in time from the infractions they were intended to sanction. The average time between first infraction and first sanction was over one month. The time between subsequent infractions and sanctions gradually declined, but sanctions and infraction were still temporally far apart, with the second sanction occur- ring within about three weeks of the second infraction, and the third about two weeks from the infraction.

Furthermore, most sanctions were relatively mild. The most common sanctions used for all types of infractions were alert letters and case reviews. Clients received treatment referrals more often for drug test infractions (missed/positive tests) than for other compliance infractions, which indicates that case managers did target responses to the type of infraction. However, other appropriate sanctions, such as increased drug testing and reassessment, appeared to be utilized infrequently. More severe sanctions, such as jail time, were rarely used because of overcrowding in the jail and judicial unwillingness to get involved in BTC sanctioning. Thus, sanctions did not become increasingly severe and were not immediate. Although most clients with infractions eventually got sanc- tioned, they were able to get away with several infractions, and clients were often able to avoid being held accountable for long periods of time.

JUDICIAL MONITORING

In general, the judges did not provide the consistent, certain response to infractions that was specified in the BTC model. Despite widespread infractions, few participants were referred for a compliance hearing and many of those received only a warning. Of the treatment group with three

202 HARRELL ET AL.

or more infractions, 86% received no judicial review hearing, 7% received a judicial warning, 3% received some days in jail, and 4% received other sanctions.

FINDINGS IMPACT ON DRUG USE

To test the hypothesis that participation in BTC reduced drug use among eligible defendants, the analysis compares 213 arrestees who partic- ipated in BTC to 137 arrestees who were processed prior to the implementation of BTC. All of these arrestees admitted drug use or tested drug positive at baseline and completed follow-up interviews.5

Drug use after the intervention period is measured by the percentage of sample members reporting any drug use in the 30 days before the second interview, defined in three ways as (1) any drug use, (2) any heroin or cocaine use, and (3) any marijuana use.6 Contrasting the pre-BTC and BTC groups on these three measures before controlling for other relevant factors indicates slightly higher likelihood of drug use by the pre-BTC group on two measures (see Table 3). However, the pre-BTC sample had considerably less opportunity to use illicit drugs, having spent an average of nine more days in jail than did the BTC group during the 30 days before the follow-up interview. That is, in spite of having less opportunity to use drugs the pre-BTC group still was more likely to have used illicit sub- stances during the period of interest.

TABLE 3. SELF-REPORTED DRUG USE IN THE 30 DAYS PRIOR TO THE FOLLOW-UP INTERVIEW

BTC sample Pre-BTC sample Significance Drug Use (n = 213) (n = 137) Level" Any Drug Use 23 % 26 Yo 0.29 Any Hard Drug Use 8% 12% 0.06 Any Marijuana Use 10% 16% 0.06 Number of Days Incarcerated 1.9 11.5 0.00

"These significance tests are all one-tailed. Chi-square tests were used for the first three comparisons, and a t-test was employed for the last comparison.

To more accurately isolate the effects of BTC, probit analysis was utilized. These models estimate the effect of BTC participation, controlling

5. BTC participants, who did not admit any drug use and did not test positive for substance use at baseline (n = 32) were admitted on the basis of a felony drug arrest and showed no indications of drug use during a month of BTC urine monitoring.

6. This drug use measure includes use of heroin, other opiates, cocaine, marijuana, amphetamines, barbiturates, other sedatives, hallucinogens, and inhalants.


for opportunity to use drugs (number of days in jail in the past 30 days prior to the follow-up interview), demographic characteristics (sex, race, age, and education), prior criminality (self-reported months of incarceration prior to BTC, any charge for a serious crime before BTC, on probation or parole at time of BTC entry, and number of self-reported offenses in the six months before baseline), employment problems (days employed in month before baseline and bothered by employment problems in month before baseline), and drug use at the start of intervention (days of drug use in the 30 days prior to the baseline interview). Tests for interactions between BTC treatment and the control variables were conducted and included in the models shown when significant at -05 level.

The first column under each dependent variable (see Table 4) examines BTC’s impact on client drug use without controlling for unmeasured selection bias, whereas the second column under each dependent variable includes a selection bias correction term from the two-stage procedure. The results show that BTC participants had a statistically significant lower likelihood of drug use at follow up than did the pre-BTC sample on all three drug use measures. This finding generally holds regardless of whether the selection correction term is included. However, the significant interaction between BTC and race indicates that BTC was associated with a reduction in any marijuana use among African-American, but not white, offenders.

Perhaps the most straightforward way of interpreting these results is to convert these estimates into predicted probabilities. These predicted probabilities are estimates of the likelihood that each group would engage in drug use holding all other factors constant (i.e., all of the other variables in the model are fixed at their respective means) (see Figure 2). The predicted probabilities show that BTC modestly reduced clients’ likelihood of using any drug and cocaine or heroin. In regard to marijuana use, Afri- can-Americans in BTC were far less likely to use marijuana in the 30 days prior to follow-up than were African-Americans in the pre-BTC sample (4% versus 18%); however, no difference was found for whites.

REDUCTIONS IN SELF-REPORTED CRIMINAL ACTIVITY

The survey instrument asked respondents to report the number of times they had committed 14 types of crimes in the last 6 months (shoplifting/ vandalism, parole/ probation violations, drug charges, forgery, weapons offenses, burglary/larceny/breaking and entering, robbery, assault, arson, rape, homicide/manslaughter, prostitution, contempt of court, and other). Responses were combined into (1) the total number of all reported offenses committed in the six months prior to the follow-up interview, and (2) any reported offense in the six months prior to the follow up interview (yeslno). Negative binomial models were used to estimate the effect of

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BTC on the total number of self-reported offenses. This variable was highly skewed: 73% reported no criminal activity. To reduce the skew in these two measures, all respondents reporting more then 31 offenses (the 95th percentile) were recoded to 31. The percentage of each sample reporting offending in the six months before the follow-up is shown in Table 5.

TABLE 5. SELF-REPORTED OFFENSES AND OFFICIAL MEASURES OF RECIDIVISM

Measure of Recidivism BTC sample Pre-BTC sample Significance

(Valid N) (Valid N) Levela

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Entry None 1-2 3 or more

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Multivariate analysis of self-reported offending (Table 6) reveals that the effect of BTC participation varied by race. Participation in BTC significantly reduced the likelihood of committing any offense, for whites but not for African-Americans in the program. The analysis of the number of self-reported offenses finds that the difference between the two groups did not reach statistical significance and this finding did not vary by race.

Figure 3 shows each groups predicted probability of offending by race, holding the other variables in the model constant at their mean.

ARRESTS IN THE YEAR AFTER SAMPLE ENTRY

The two samples of offenders were compared on any arrest and number of arrests in the 12 months after sample entry.7 These official measures of recidivism covered a longer period of time than did the self-report survey (12 versus 6 months), and they provide objective measures of continued criminal activity, free from the potential sources of error inherent in self- report measures (e.g., recall error, selective reporting), but limited to offenses that are reported to or detected by the authorities. The analysis controls for all of the same variables as the above analyses, but it includes

7. Records for 23 BTC participants could not be located and therefore they are excluded from this portion of the analysis.

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a measure of official criminal history (number of prior arrests).8 The results show significant and sizable reductions in arrests as a function of BTC and race, regardless of whether the selection bias correction is included (see Table 6).

Figure 3 also interprets these same results in terms of predicted probabilities. These predicted probabilities reflect the likelihood of being arrested in the 12 months after sample entry. Overall, BTC participation reduced the likelihood of arrest for both blacks and whites; however, the magnitude of this effect was greater for whites. Furthermore, the negative binomial regression indicates that BTC participation also reduced the number of arrests incurred. These results from this model are used to cal- culate predicted mean number of offenses by group and race, holding all variables in the model at the mean. Following such a procedure reveals that the predicted mean number of arrests for African-Americans involved in BTC was .46 compared with .93 for African-Americans in the pre-BTC group. The difference is even greater for whites: Whites in the BTC group were predicted to have .26 arrests versus 1.28 for whites in the pre-BTC group. Comparing the results of the analyses of self-report and official measures of recidivism reveals a similar picture: BTC reduced recidivism but more so for whites than for African-Americans.

DISCUSSION

The results suggest that intervention with drug-involved offenders can, as a practical matter, begin shortly after arrest for a much larger portion of the arrestee population than is targeted by drug courts or pretrial diversion programs. Although drug courts accept defendants who want to join, are charged with drug offenses, and have no pending charges or prior convictions for violent offenses, BTC accepted defendants with most felony charges, providing they qualified for a bond and were able to secure release. BTC succeeded in making referral for drug screening a routine condition of release, using lower bonds as an incentive for cooperation. In Birmingham, most felony defendants living within the jurisdiction who obtained pretrial release from jail on bond were required to undergo screening and participate in treatment and drug testing as needed prior to case disposition. BTC added drug screening, ongoing drug testing, referrals to treatment, and responses - albeit not swift, certain, or severe responses - to failures to take drug tests, test drug-free, and otherwise comply with BTC rules. The program records indicate that drug users were referred to treatments that were appropriate for the level of severity

8. The number of days in jail in the 30 days prior to follow-up was excluded from these models because it may be causally related to recidivism.

210 HARRELL ET AL.

of their drug problems and, moreover, that most of those referred to treatment were placed in services. The result was a substantial increase in the pool of defendants released, which helped reduce jail overcrowding without a significant increase in threat to public safety.

Indeed, the findings indicate that the benefits of this model of early intervention with drug-involved felony defendants include significant reductions in drug use and some reduction in crime. Reductions in offending were found in both the self-report data on crimes committed and arrests in the year after entry among white, but not African-American, BTC participants. Although there is always the risk that stigmatized behaviors like drug use and crime will be underreported on surveys, our comparisons of responses to drug tests (for a subset of BTC clients) and arrest records (for all subjects) suggest that underreporting did not pose a major threat in this study. The consistency of the findings based on self- report criminal activity and arrest records is reassuring in this regard. The promising results are, however, based on the experiences in a single jurisdiction. Because BTC services in Birmingham were not extended to those on probation, it is not clear whether defendants not facing sentencing would respond in the same way. It is possible, for example, that the impact is limited to defendants who recognize that their drug use is being monitored and that their behavior may be taken into account at sentencing. Alternatively, if BTC services are extended past sentencing to those on probation, the impact may be greater. These findings also leave open the question of what effects would be observed by incorporating judicial review hearings and more systematic use of sanctions. Replications underway in Jacksonville and Tacoma will provide evidence on BTC implementation and impact on jurisdictions facing different constraints and drug problems.

As a feasibility study, BTC efforts to create sustained coordination across criminal justice agencies in the handling of felony defendants produced significant lessons that could guide future program planning and potentially support the implementation of programs with even greater fidelity to the lessons of effective intervention and even larger reductions in drug use and crime. Taking the lessons to scale in Birmingham involved screening over 3,000 defendants, over half within a week of arrest, and providing case management and referrals to drug testing or treatment for 84% of them.

The challenges facing implementation of expanded criminal justice drug interventions must be recognized and require detailed advance planning. The Birmingham case study revealed the following major barriers to change:

A severely overcrowded jail limiting the space and staff to conduct drug tests and treatment sessions for inmates

FINDINGS FROM THE BIRMINGHAM BTC 21 1

Heavy case backlogs clogging the court dockets, which contributed to judicial reluctance to hold review hearings The difficulties inherent in engaging state-managed agencies in local innovations in the absence of any incentives for participation Lack of computer systems and technology to support client tracking and interagency exchange of information on a timely basis Lack of a history of interagency collaboration around system problem solving, the priority for agencies to focus on their immediate budget and staffing problems, and the competition for funds (A single agency cannot direct system-wide reform. Only collectively can agencies devise ways to share resources to serve the interests of all. An understanding that reform involves political risk for elected officials and can introduce competition between officials of different political parties.

Jurisdictions that undertake such sweeping changes need to engage in advance planning that identifies the roles, requirements, and resources for each agency in the network of collaborators; establish an interagency management strategy that will continue to meet and solve problems; and computer systems that can exchange person-level information on a real-time basis to enable agencies to coordinate their services to large numbers of individuals.

Despite these challenges, BTC made important and lasting contribu- tions to the functioning of the justice system in Birmingham. One was the implementation of procedures for widespread drug testing and monitoring for defendants on pretrial release. TASC developed automated drug testing procedures to manage a large number of defendants, developed capacity for on-site drug testing in court, and implemented a sophisticated management information system for storing client assessments, tracking client supervision and drug test results, and generating court reports, but it did not, unfortunately, link to criminal justice information systems.

The demonstration program also helped to increase coordination among the partner agencies and established a forum for future planning. The availability of BTC services was an important consideration in the court’s decision to expand options for releasing detained offenders into the community subject to participation in drug testing and treatment through deferred prosecution, referral to drug court, and an expedited docket for cases involving drug charges. The importance of BTC in these initiatives is underscored by the decision of the Jefferson County Commissioners to continue funding the pretrial BTC intervention after the end of federal funding, in lieu of raising funds for additional jail space.

212 HARRELL ET AL.

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Implementing System-Wide Interventions For Drug-Involved Offenders in Birmingham, Alabama: Evaluation Of The Breaking The Cycle Demon- stration. Washington, DC: The Urban Institute.

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Evaluation of the First Year of Operation of the Jackson County Drug Court. Kansas City, Mo.: Ewing Marion Kauffman Foundation.

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First Report to the State Justice Institute. Alexandria, Va.: State Justice Institute.

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Dr. Adele Harrell, Ph.D., is the Director of the Justice Policy Center at the Urban Institute and has been engaged in studies of drug abuse since 1975. She is currently evaluating the Brooklyn Treatment Court services for female offenders and Breaking the Cycle. Her prior research includes an evaluation of system-wide drug testing in case management at pretrial, probation and parole, and studies of the relationship between arrestee urinalysis results and community indicators of drug problems among adults and juveniles. She recently completed a five-year experimental evaluation of the DC Drug Court.

Ojmarrh Mitchell is a Jerry Lee Research Associate at the University of Maryland. Mr. Mitchell has worked on the evaluations of Breaking the Cycle and the District of Columbia Truth-in Sentencing project, for which he examined the effect of defendants’ criminal history on the certainty and severity of imposed sentences. Mr. Mitchell was previously involved in the National Evaluation of Juvenile Correctional Facilities, and he recently co-authored a chapter on the evolution of juvenile courts and potential future directions of juvenile justice in America.

Alexa Hirst was a research associate in the Justice Policy Center at the Urban Insti- tute. She was working on the evaluations of two multi-site interventions for offenders: Breaking the Cycie and teen courts. In the past, she has helped to conduct evaluations of other court-based programs, and has examined the effect of perceived fair treatment on offender compliance with court mandates. Ms. Hirst has also supported research in delinquency prevention programs, such as the SafeFutures initiative and Children At Risk.

Douglas B. Marlowe, J.D., Ph.D., is the Director of the Section on Criminal Justice Research at the University of Pennsylvania’s Treatment Research Institute (TRI). Dr. Marlowe is also an Adjunct Associate Professor of Psychology in Psychiatry at the Uni- versity of Pennsylvania School of Medicine. His past research has focused on character- izing and measuring coercive and non-coercive pressures to enter substance abuse treatment, evaluating the efficacy of coercive interventions for substance abusers, and identifying the operative components of drug courts and other criminal diversion programs.

Dr. Jeffrey Merrill, Ph.D., is the University Research Professor and Professor of Psy- chiatry at the Robert Wood Johnson Medical School. He is currently involved in studies examining the prevention of substance abuse and related risk behaviors in children and adolescents. Dr. Merrill has also been involved in a number of projects looking at the


diversion of substance-abusing criminal offenders into treatment programs, including BTC and a study of drug courts in Delaware. He is also active in a number of projects studying the impact of drug treatment on TANF (welfare recipients).

21 6 HARRELL ET AL.

Documents

BREAKING THE CYCLE OF DRUGS AND CRIME: FINDINGS FROM THE BIRMINGHAM BTC DEMONSTRATION