Elements of Successful Drug Treatment Courts

Veterans’ Treatment Court

Elements of Successful Drug Treatment Courts

Elements of successful Veterans Treatment Courts

General findings and themes across Veterans’ Court suggest that the integrated care approach employed in these types of specialty courts is important, particularly in addressing issues such as mental health and substance use treatment, housing, and employment

General Findings

  • Within the incarcerated veteran population, veterans are less likely to accept community sanctions, such as veterans’ court, in lieu of prison sentences than non-veteran offenders (May, Stives, Wells, 2017)
  • Components of Veterans courts that were found to be particularly effective include trauma-focused treatment, peer mentorship, medication therapy (Knudsen & Wingenfeld, 2016)
    • VTCs use team approach and VA providers and volunteer veteran mentors are involved in the rehabilitation process (Johnson et al., 2016, Tsai et al., 2017)
  • One study comparing veterans’ court participations to other specialty court programs (e.g. drug court, problem solving court) found that veterans’ court participants were more likely to be housed at the end of the program and had better employment outcomes (Tsai et al., 2017)
  • Longer stay in the program reduced the likelihood of recidivism regardless of number of sanctions issued by the judge (Johnson et al., 2015)
  • The most significant veteran barriers to securing treatment services were distance, accessibility of VA services and timeliness of VA services (Johnson et al., 2016).
  • Peer mentoring, trauma treatment, psychiatric medication, and substance abuse services were related to positive clinical outcomes, such as improvements in PTSD symptoms, family relations, substance abuse, emotional well-being, overall energy, depression, housing at 6 and 12 month follow up (Knudsen & Wingenfeld, 2016). More specifically:
    • Peer support positively predicted improvements in social connections
    • Trauma treatment significantly predicted improvements in PTSD, depression, functioning and emotional limitations
    • Inpatient substance abuse treatment? predicted improvements in substance abuse and sleep
    • Psychiatric medication was related to improved depression, emotional lability, psychosis and functioning

Specific Studies

Johnson et al 2016 [US Veterans’ Court Programs: An inventory and analysis of national survey data] did national survey of 302 courts:

  • 97 % of veterans’ courts work in close partnership with a VA Health Care Network, while only 14 % of courts restrict their caseload to veterans with mental health conditions
  • Regarding eligibility, 34 % of courts accepted only veterans who were eligible for VA benefits, 22 % placed an emphasis on OEF/OIF veterans; 47 % of courts accepted cases from outside of their jurisdiction, 77 % of courts accepted felony cases, 86 % accepted post-plea veterans while 60 % accepted pre-plea veterans.
  • The most common sanction was a verbal reprimand (96 %), while the least common sanction was placing the veteran in a holding cell for the duration of the docket (35 %).
  • The most common reward was verbal praise (98 %), while the least commonly used reward was a gift certificate (44 %).
  • The following were associated with higher rates of termination from the VC program: phase progression based on measurable goals, permitting post-plea veteran defendants, accepting veterans from outside jurisdictions, conducting frequent drug and alcohol testing, sanctions are more severe for failing immediate goals (e.g. sobriety) versus long-term ones (e.g.  completing of training). The authors note that some of these results may reflect increased scrutiny thus resulting in higher rates of termination.  
  • The following were associated with lower rates of termination from the VC program: including Reserve/National Guard veterans; later phases permit less stringent testing; utilizing behavioral contracts; utilizing brief incarcerations; and working in close partnership with a VA Health Care Network
  • Blonigen et al (2017) interviewed Veterans Justice Outreach Specialists, Healthcare for reentry veteran specialists regarding practices and perspectives in the treatment of recidivism risk among justice involved veterans.
  • Common risk factors and how to address them included (majority of those interviewed reported these):
  • Substance Abuse: referral to outpatient and residential treatment programs and self help groups in the VA and community, motivational interviewing or brief MET to increase motivation for SA treatment, utility of peer support specialists through either VA or VTC who help increase engagement and motivation for treatment and structured CBT groups (e.g. MRT)
  • Lack of school/work: referrals to specialized employment services in VA or community, referrals to veterans service organization or veterans benefits administration representative to determine eligibility, peer groups or support specialist who can assist with developing job skills, networking, and increasing motivation to seek gainful employment
  • Family/marital dysfunction: couples counseling, interpersonal violence programs
  • Lack of activities/interests: recreational/volunteer groups, residential behavioral health programs, peer support to facilitate engagement

    Other notable findings:

  • Only a little more than half of the responses included description of any treatment options or resources to address antisocial tendencies and antisocial peers. When included, indicated importance of setting limits and maintaining clear boundaries, sanctions/rewards, informal conversation about behavior and choices.
    • Perceived lack of treatability appeared to contribute to lack of consideration of antisocial tendencies.
    • Noteworthy given that risk factors related to antisociality are typically strong predictors of criminal recidivism
    • This could be potential gap in the implementation of best practices to reduce recidivism in this population
    • Provide more education to providers and encourage focus on not only unique challenges to veterans, but also re-entry challenges of all offenders
  • Peer based services were perceived as being a useful resource to address nearly all risk factors
  • For all risk factors, the use of motivational interviewing and/or cognitive behavioral techniques to help veterans modify their behavior and increase motivation for behavioral change and treatment engagement – this is consistent with “what works” for reducing risk of recidivism
References: 

Blonigen, D.M., Rodriguez, A.L., Manfredi, L., Britt, J., Nevedal, A., Finlay, A., Rosenthal, J., Smelson, D., & Timko, C. (2017). Criminal Justice Policy Review, 28, 790-813. https://doi.org/10.1177/0887403416628601

Johnson, R.S., Stolar, A.G., McGuire, J.F., Clark, S., Coonan, L.A., Hausknecht, P., & Graham, D.P. (2016). US Veterans’ court programs: An inventory and analysis of national survey data. Community Mental Health Journal, 52, 180-186. DOI 10.1007/s10597-015-9972-3.

Johnson, R.S., Stolar, A.G., Wu, E., Coonan, L.A., & Graham, D.P. (2015). An analysis of successful outcomes and associated contributing factors in veterans’ court. Bulletin of the Menninger Clinic, 79, 166-173. https://doi.org/10.1521/bumc.2015.79.2.166

Knudsen, K.J. & Wingenfeld, S. (2016). A specialized treatment court for veterans with trauma exposure: Implications for the field. Community Mental Health Journal, 52, 127-135. https://doi.org/10.1007/s10597-015-9845-9.

May, D.C., Stives, K.L., Wells, M.J., & Wood, P.B. (2017). Does military service make the experience of prison less painful? Voices from incarcerated veterans. Criminal Justice Policy Review, 28, 770-789. https://doi.org/10.1177/0887403416628600

Tsai, J., Flatley, B., Kasprow, W.J., Clark, S., & Finlay, A. (2017). Diversion of veterans with criminal justice involvement to treatment courts: Participant characteristics and outcomes. Psychiatry Services, 68, 375-383. doi:10.1176/appi.ps.201600233.