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W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 3 OCTOBER 17, 2014 Washington is one of a few states in the nation with an integrated social service client database
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WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
1
OCTOBER 17, 2014
Drug Court Evaluation:The Impact of Recovery Support Services
Washington State Association of Drug Court Professionals
17th Annual ConferenceOCTOBER 17, 2014
Jim Mayfield and Paula Ditton Henzel DSHS Research and Data Analysis Division
Getty Images, iStock
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
2
OCTOBER 17, 2014
Our topic today . . . .
1. Review social service and criminal justice data integration in Washington State
2. Demonstrate the use of integrated data to evaluate drug courts
3. Present evaluation of recovery support services provided to drug court participants
Series1
3x HIGHER
Getty Images, iStock
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
3
OCTOBER 17, 2014
Washington is one of a few states in the nation with an integrated social service client database
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
4
OCTOBER 17, 2014
. . . and at an individual or family level
That means we can identify costs, risks and outcomes at the state or community level . . .
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
5
OCTOBER 17, 2014
Nursing Facilities
In-home Services
Community Residential
Functional Assessments
Case Management
Community Residential Services
Personal Care Support
Residential Habilitation Centers and Nursing Facilities
Medical and Psychological Services
Training, Education, Supplies
Case Management
Vocational Assessments Job Skills
Child Protective Services
Child Welfare Services
Adoption
Adoption Support
Child Care
Out of Home Placement
Voluntary Services
Family Reconciliation Services
Institutions
Dispositional Alternative
Community Placement
Parole
Food Stamps
TANF and State Family Assistance
General Assistance
Child Support Services
Working Connections Child Care
Juvenile Rehabilitation
Economic Services
Aging and Long-Term Support
Developmental Disabilities
Vocational Rehabilitation
Children’s Services
Child Study Treatment Center
Children’s Long-term Inpatient Program
Community Inpatient Evaluation/ Treatment
Community Services
State Hospitals State Institutions
Assessments
Detoxification
Opiate Substitution Treatment
Outpatient Treatment
Residential Treatment
Mental HealthSubstance Abuse Services
DSHS Client Services Database
External
School Outcomes Preschool – College
Arrests Charges
Convictions
Incarcerations
Community Supervision
Dental ServicesMedical Eligibility Medicaid, State OnlyHospital Inpatient/ OutpatientManaged Care Physician ServicesPrescription Drugs
Hours
Wages
Housing AssistanceEmergency ShelterTransitional HousingHomeless Prevention and Rapid Re-housing Permanent Supportive Housing
Public HousingHousing Choice VouchersMulti-Family Project-Based Vouchers
Internal
Administrative Office
of the Courts
Employment Security
DepartmentDepartment
of CorrectionsWashington State Patrol
Department of Commerce
Health Care Authority
Housing and Urban
Development Public Housing
Authority
WASHINGTON STATEDepartment of Social and Health Services
Integrated Client Databases
Education Research Data
Center
De-identified
Births
Deaths
Department of Health
Integrated Client Databases (ICDB)
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
(Includes dropouts)
Drug court participants and study sample
June 2007 through July 2009
Reported admissions (unduplicated)* 2,537
• Opt outs 582
• Did not link with the ICDB 121
• Missing critical data 163
Final Drug Court Sample 1,671
*SOURCE: Administrative Office of the Courts, individual drug courts, and DCCM.
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
-10 years -9 years -8 years -7 years -6 years -5 years -4 years -3 years -2 years -1 year +1 year +2 years +3 years
INDEXDate felony was filed
Baseline characteristics up to 10 years prior 3 years after filing date
• Age, gender• Race and ethnicity• Employment history• Location
• Arrest rate• Incarceration rate• Days incarcerated• Received AOD treatment• Days of AOD treatment• AOD treatment cost
• Most serious felony charge• Criminal history• AOD treatment need• Previous AOD treatment
BASELINE PERIOD FOLLOW-UP PERIOD
STUDY TIMELINE: Admissions from June 2007 through July 2009
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
8
OCTOBER 17, 2014
Nursing Facilities
In-home Services
Community Residential
Functional Assessments
Case Management
Community Residential Services
Personal Care Support
Residential Habilitation Centers and Nursing Facilities
Medical and Psychological Services
Training, Education, Supplies
Case Management
Vocational Assessments Job Skills
Child Protective Services
Child Welfare Services
Adoption
Adoption Support
Child Care
Out of Home Placement
Voluntary Services
Family Reconciliation Services
Institutions
Dispositional Alternative
Community Placement
Parole
Food Stamps
TANF and State Family Assistance
General Assistance
Child Support Services
Working Connections Child Care
Juvenile Rehabilitation
Economic Services
Aging and Long-Term Support
Developmental Disabilities
Vocational Rehabilitation
Children’s Services
Child Study Treatment Center
Children’s Long-term Inpatient Program
Community Inpatient Evaluation/ Treatment
Community Services
State Hospitals State Institutions
Assessments
Detoxification
Opiate Substitution Treatment
Outpatient Treatment
Residential Treatment
Mental HealthSubstance Abuse Services
DSHS Client Services Database
External
School Outcomes Preschool – College
Arrests Charges
Convictions
Incarcerations
Community Supervision
Dental ServicesMedical Eligibility Medicaid, State OnlyHospital Inpatient/ OutpatientManaged Care Physician ServicesPrescription Drugs
Hours
Wages
Housing AssistanceEmergency ShelterTransitional HousingHomeless Prevention and Rapid Re-housing Permanent Supportive Housing
Public HousingHousing Choice VouchersMulti-Family Project-Based Vouchers
Internal
Administrative Office
of the Courts
Employment Security
DepartmentDepartment
of CorrectionsWashington State Patrol
Department of Commerce
Health Care Authority
Housing and Urban
Development Public Housing
Authority
WASHINGTON STATEDepartment of Social and Health Services
Integrated Client Databases
Education Research Data
Center
De-identified
Births
Deaths
Department of Health
Routinely updated ICDB data sources
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
9
OCTOBER 17, 2014
-10 years -9 years -8 years -7 years -6 years -5 years -4 years -3 years -2 years -1 year +1 year +2 years +3 years
INDEXDate felony was filed
• ADMITTED to Drug Court
BASELINE PERIOD FOLLOW-UP PERIOD
• NOT Admitted to Drug Court• BUT statistically similar
STUDY TIMELINE and Comparison Group
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
10
OCTOBER 17, 2014
Study population characteristicsAdults admitted to Drug Courts and a matched comparison group
are statistically identical across multiple dimensions
“Index” Felony:
• The most serious charge associated with admission to drug court
Demographics
• Age
• Gender
• Race/Ethnicity
Criminal History
• Felony Convictions by Type
• Misdemeanor Convictions by Type
• Arrests
• Juvenile Crime
Other Characteristics
• AOD Treatment Need
• AOD Treatment & Detox History
• Employment History
• Geography
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
11
OCTOBER 17, 2014
Series1
3x HIGHER
Getty Images, iStock
Study questions . . . .
1. How do drug courts influence incarceration (prison only)?
2. What is the impact of drug court on subsequent arrest rates?
3. How do drug courts influence treatment participation?
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
Drug Court participants were less likely to be incarceratedCumulative incarceration rate over the three-year follow-up period Drug Court and comparison group clients—DOC facilities only
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36
-10%
0%
10%
20%
30%
MONTHS AFTER INDEX FELONY CHARGE
Drug Court group
Comparison group23%
17%
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
13
OCTOBER 17, 2014
Drug Court participants in the community were less likely to be re-arrested
Cumulative arrest rate over the three-year follow-up period for individuals in the community Drug Court and comparison group clients
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 360%
30%
60%
90%
MONTHS AFTER INDEX FELONY CHARGE
Drug Court group
Comparison group 85%
71%
Graduates
61%
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
14
OCTOBER 17, 2014
Drug Court participants were more likely to remain free of arrest
*Based on a multivariate predictive model.
Series1
15%
30%
Arrest-free during follow-up period*Adjusted
Drug Court Group
Comparison Group
2x HIGHER
n = 1,290 n = 1,384
*
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
Chemical dependency treatment experiences differed significantly
Any AOD Treatment received during follow-up
DRUG COURT GROUP COMPARISON GROUP
3%No Treatmentn = 53
97%Received Treatment
n = 1,618 54%No
Treatmentn = 896
46%Received Treatmentn = 775
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
Drug Court participants entered treatment more quickly
TIME TO TREATMENT
179
115 Drug Court
Group
Comparison Group
64DAYS EARLIER TO TREATMENT
n = 775 n = 1,618 Series1
16%
55%
Drug Court Group
Comparison Group
3x HIGHER
n = 775 n = 1,618
Number of days before entering
treatment
Percent entering treatment within 90 days
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
Drug Court participants entering treatment stayed longer
DAYS IN TREATMENT
Series1
62
190
Drug Court Group
Comparison Group
128 MORE
DAYS IN TREATMENT
n = 775 n = 1,618 Series1
18%
73%
Drug Court Group
Comparison Group
4x HIGHER
n = 775 n = 1,618
Number of days spent in treatment
Percent spending 90 days or more in treatment
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
1. Updated drug court participation data: 2008 through 2012
2. The Administrative Office of the Courts will update drug court participation data annually
3. 2014 legislation granted specific agencies (including DSHS) access to jail bookings and releases, statewide
Series1
3x HIGHER
Getty Images, iStock
Next steps . . . .
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
Series1
3x HIGHER
Getty Images, iStock
Drug Court and Recovery Support Services
OUTCOME EVALUATIONPreliminary Findings
OCTOBER 17, 2014
Paula Ditton HenzelWashington State Department of Social and Health Services
Research and Data Analysis Division
wa•cares
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
Overview
WA-CARES and Recovery Support Services
Study Design
Outcomes
Do recovery support services have an impact on:
• Substance use disorder treatment?
• Employment?
• Re-Arrest and Incarceration?
Conclusions
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
The WA•CARES Project
WA-CARES is a collaborative project between . . . • DSHS Division of Behavioral Health and Recovery• The Administrative Office of the Courts• Nine independent, county-level drug courts
WA-CARES addresses . . . • Implementation of an automated drug court case
management system• Recovery support services (RSS) provided to drug
court participants in select drug courts
Preliminary report identifies. . . • WA-CARES participant characteristics and
preliminary outcomes for RSS and Non-RSS (Drug Court Case Management, or DCCM) sites
Full report available from DSHS Research and Data Analysis Division at:
http://publications.rda.dshs.wa.gov/1503/
WA-CARES was funded by . . . • Grant funds from the Substance Abuse and Mental
Health Services Administration (SAMHSA)• Bureau of Justice Assistance (BJA)
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
Recovery Support Services (RSS) Identify and address potential barriers to recovery and drug court success Include funds for services to address needs around employment and job training,
transportation, clothing, medical and legal problems, child care, and parenting education, among other basic needs
Participating SitesSan Juan
Clallam
SkagitOkanogan
Snohomish
Lewis
Yakima
Cowlitz
Whatcom
King
PierceThurston
Jefferson
Island
Kitsap
MasonGrays Harbor
Pacific
Wahkiakum
Clark
Skamania
Klickitat
Kittitas
Chelan
Douglas
Grant
Benton
Franklin
Walla Walla
Columbia
Garfield
Asotin
Adams
Lincoln
Whitman
Spokane
Pend Oreille
Stevens
Ferry
Recovery Support Service SitesOther WA•CARES SitesNew WA•CARES site, Fall 2013
NOTE: Clallam, Skagit, Okanogan began providing RSS services in June 2011, Snohomish in January 2012, and Cowlitz October 2012. Mason became
an active WA-CARES site in 2013.
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
Recovery Support Services
NOTE: Includes only RSS services provided to the 175 clients identified for this study.
$48,535
$39,832
$39,102
$31,917
$23,833
$19,739
$12,663
$6,630
$6,310
$5,072
$2,402
$940
$705
$654
$490
$448
$114
$60
Total Services Provided
Number of
ClientsServed
Basic Needs 492 117
Transportation 748 100
Dental 58 26
Legal 30 13
RSS Assessment 171 155
Financial 56 28
Recovery Coordination 561 114
Employment 29 18
Education 27 16
Medical 17 7
Vision 11 6
Pharmacy 5 3
Home Safety 3 1
Alcohol and Drug Free Activities 5 5
Mental Health Treatment 7 1
Child Care 1 1
Spiritual Support 2 2
Other 6 month Incentive 3 3
Average Number of Services Provided 13Average Expenditure $1,392
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
Study Design RSS Group: 175 clients admitted to drug court during the first 2 years of WA-CARES
(January 2011 – December 2012) who received recovery support services
Matched Comparison Group: 175 drug court participants admitted to drug court during the same time period who did not receive recovery support through WA-CARES
Pre-Period24 months
INDEXDrug Court
admission datePost-Period
12 months
• Demographics (Age, Gender, Race/Ethnicity)
• Most serious felony charge
• Criminal history• Previous substance use
disorder treatment• Urban/rural county
• Treatment• Employment• Arrests and DOC
Incarceration
• Mental Health• Employment history• Medicaid eligibility• Basic Food• Homelessness• County arrest rate• County unemployment rate
RSS and Non-RSS similar histories and characteristics
Matched based on:
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
RSS recipients entered treatment sooner and spent more time in treatment
72 percent of RSS recipients entered substance use disorder treatment within 7 days, compared to 58 percent of those without RSS (p < .01)
RSS clients participated in about 133 days of treatment, compared to 95 days for those without RSS (p < .0001)
Entry within 7 DaysAmong clients who received
treatment*
Days in TreatmentAmong clients who received
treatment*
0
58%
72%p < .01
n = 123 of 172 n = 87 of 151
RSS
No RSS
0n = 172 n = 151
133 days
95 days
p <.0001
RSS
No RSS
*Unadjusted
PRELIMINARY
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
RSS recipients are more likely to become employed Despite having similar rates of employment prior to entering drug court, RSS recipients
had much higher rates of employment in the fourth quarter following admission than those without RSS (46% versus 29%)
— 4 — 3 — 2 — 1 + 1 + 2 + 3 + 40%
10%
20%
30%
40%
50%
21%
46%
32% 29%
Pre-period Post-periodQuarters before and after Drug Court admission date
RSS
No RSS
Employment OutcomesPercent with earnings by quarter 4 quarters pre- and post- Drug Court admission date
PRELIMINARY
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
27
OCTOBER 17, 2014
RSS recipients were less likely to be arrested Over the course of the 12-month follow-up period 34% of the RSS group were arrested,
compared to 46% of those without RSS (p < .05) The felony arrest rate was also lower among RSS recipients, although the difference
between the two groups did not reach statistical significance
Any Re-ArrestPercent with any re-arrest
during follow-up*
Felony Re-ArrestPercent with felony re-arrest
during follow-up*
n = 60 of 175 n = 80 of 175
46%
34%
p < .05
RSS
No RSS
n = 42 of 175 n = 51 of 175
29%24%
n.s.
RSSNo RSS
0 0
PRELIMINARY
*Unadjusted
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
RSS appears to reduce the rate of incarceration Just 5 percent of RSS recipients were incarcerated during the follow-up period,
versus 19 percent of those without RSS (p < .0001) 38 percent of the RSS group were arrested or incarcerated in a Department of
Corrections facility, compared to just over half (53 percent) of those without RSS (p < .01)
State Prison Incarceration Rate
Percent incarcerated at any time during follow-up*
Any Re-Arrest or State Prison Incarceration
Percent at any time during follow-up*
0
19%
5%
p < .0001
n = 8 of 175 n = 33 of 175
RSS
No RSS
0n = 66 of 175 n = 93 of 175
53%
38%
p < 0.01
RSS
No RSS
PRELIMINARY
*Unadjusted
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
In Conclusion
Compared to similar drug court clients over a 12-month follow-up period we found that:
Clients who received recovery support services spent more time in substance use disorder treatment
Recovery support recipients had higher rates of employment
Rates of arrest and incarceration in a Department of Corrections facility were significantly lower for RSS recipients
Findings related to WACARES can be found at: http://www.dshs.wa.gov/rda/
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DSHS | Research and Data Analysis
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OCTOBER 17, 2014
Questions?
FOR MORE INFORMATIONWashington State Department of Social and Health Services
Research and Data Analysis [email protected] 360.902.0792
