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Program Profile: Juvenile Drug Courts With Contingency Management and Multisystemic Therapy

Evidence Rating: Promising - More than one study Promising - More than one study

Date: This profile was posted on February 12, 2015

Program Summary

Incorporates contingency management protocols and multisystemic therapy into traditional juvenile drug court services to provide juveniles and families with additional engagement opportunities and support in order to reduce recidivism and substance abuse. The program is rated Promising. The program significantly reduced alcohol and poly drug use, positive drug urine screens, status offenses, and property offenses. The program had mixed effects on marijuana use and offenses against persons.

Program Description

Program Goals
Juvenile drug courts are problem-solving courts for cases involving substance-abusing juveniles in need of specialized treatment services. The emphasis is on providing treatment to eligible, drug-involved juvenile offenders with the goal of reducing recidivism and substance abuse. The addition of the contingency management protocol and multisystemic therapy provides juveniles and families with additional engagement opportunities and support to improve the juvenile’s behavior.

Program Components/Services Provided
Juvenile drug courts are administered by a team of professionals, including court personnel (such as judges) and other treatment and social service providers. Juvenile drug court programs involve drug testing, ongoing case management, and weekly status hearings. In addition, treatment providers work closely with juvenile offenders and their families to target substance use and related problem behaviors.

Contingency management is a threefold process consisting of 1) addressing the target behavior or behaviors, 2) providing tangible reinforcers when those behaviors are exhibited, and 3) removing incentives when those behaviors are not shown (Petry 2000).

Integrating the contingency management protocol with juvenile drug court services includes several components. The first component is the use of validated instruments and clinical interviews to determine the extent of the juvenile’s substance use. The scale ranges from experimental use to abuse/dependency. If the juvenile’s substance use is measured toward the latter end of the scale, he or she is introduced to the contingency management protocol and referred to treatment services.

At that time, a therapist employed by a community-based service provider collaborates with the juvenile and parents/guardians to analyze the juvenile’s substance use behaviors. Referrals are made to self-management and drug refusal skills training, then the juvenile and parents/guardians create a contingency contract to outline rewards for negative substance screens and consequences for positive ones.

Contingency contracts include a list of reasonable rewards for abstaining from substance use. These include incentives such as Internet access, a later curfew, or gift cards to stores or restaurants. A voucher system with levels and points is assigned to the list of incentives to encourage juveniles to abstain from substance use. Points are earned or lost based on drug screens and can be redeemed for rewards at any time.

At program completion, the therapist works with the juvenile and parents/guardians to create an aftercare plan.

Multisystemic therapy enlists the support of family members in the treatment process. The juvenile drug courts incorporate key therapeutic elements and skills building of multisystemic therapy into their creation and implementation of treatment programs. Key strategies include juvenile and family collaboration in the development of treatment goals, conceptualizing interventions to meet those goals, maintaining a nonblaming stance, and incorporating skills such as empathy, reflective listening, and flexibility. The overall goal of multisystemic therapy is to keep juveniles who exhibit serious problems—such as criminal behavior—at home, in school, and out of trouble. Juveniles are treated in the environments where their problem behaviors exist (i.e., home, school) rather than in an unfamiliar environment (i.e., custody) to enable change.  

Evaluation Outcomes

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Study 1
Alcohol Use
Henggeler and colleagues (2006) found that juveniles in the drug court with multisystemic therapy enhanced with contingency management (DC/MST/CM) condition reported significantly less alcohol use at 12 months following treatment than juveniles in the usual family court with community services (FC) condition.

Marijuana Use
Juveniles in the DC/MST/CM condition reported significantly less marijuana use at 12 months after treatment than juveniles in the FC condition.

Poly Drug Use
Juveniles in the DC/MST/CM condition reported significantly less polydrug use at 12 months following treatment than juveniles in the FC condition.

Drug Urine Screening
Between the 4­- and 12-month posttreatment surveys, juveniles in the DC/MST/CM condition had significantly lower percentages of positive screens than juveniles in the FC condition.

Status Offense
Juveniles in the DC/MST/CM condition reported significantly fewer status offenses at 12 months following treatment than juveniles in the FC condition.

General Theft
There were no significant differences reported between treatment conditions on general theft at 12 months following treatment.

Crimes Against Persons
Juveniles in the DC/MST/CM condition reported significantly fewer crimes against persons at 12 months following treatment than juveniles in the FC condition.

Child Behavior Checklist
There were no significant differences between treatment conditions reported for symptoms on the Child Behavior Checklist at 12 months after treatment.

Days in Out-of-Home Placement
There were no significant differences between treatment conditions on the average number of days in out-of-home placement throughout the study period.

Study 2
Urine Drug Screens: Marijuana
Henggeler and colleagues (2012) found that during the first 3 months of the study, 28 percent and 25 percent of youths in the contingency management­–family engagement (CM–FAM) condition and treatment-as-usual groups, respectively, tested positive for marijuana at least once. During the next 6 months, youths in the CM­–FAM condition showed a marginally significant increase in marijuana use. Over the next 3 months, youths in the CM–FAM condition showed a significantly greater reduction in marijuana use in comparison with the treatment-as-usual group. For example, from months 1–3 to months 7–9, the odds of a positive marijuana result per drug screen for treatment-as-usual youths increased 94 percent. During the same time, the odds of a positive marijuana result per drug screen decreased 18 percent for CM–FAM youths.

Timeline Follow-Back: Marijuana
During months 7–9 post baseline, 30 percent of youths in both conditions reported using marijuana, resulting in no significant differences between the groups.

Self-Report Delinquency Scale (SRD) General Delinquency
During months 7–9 after baseline, there were no significant differences between groups on self-reported general delinquency.

SRD Person Offenses
During months 7–9 following baseline, juveniles in the CM–FAM group reported a significant decrease in the rate of person offenses (73 percent), whereas juveniles in the treatment-as-usual group reported a significant increase (95 percent) in the rate of person offenses.

SRD Property Offenses
During months 7–9 following baseline, juveniles in the CM–FAM group reported a significant decrease in the rate of property crimes, compared with the treatment-as-usual group (88 percent, compared with 66 percent). 
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Evaluation Methodology

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Study 1
Henggeler and colleagues (2006) conducted a randomized experimental design with intent-to-treat analysis to evaluate the impact on substance use, criminal behavior, incarceration, and symptomology of various interventions integrated into three juvenile drug courts (JDCs) in Charleston County, S.C.

The study population was recruited from the South Carolina Department of Juvenile Justice. The final sample consisted of 161 substance-abusing and -dependent juvenile offenders (according to the DSM–IV, Fourth Edition), ages 12 through 17. Youths were excluded if they were already formally involved in substance abuse treatment or if a family member had already received Multisystemic Therapy (MST) treatment.

Offenders were randomly assigned to one of four treatment conditions: 1) family court with community services (FC), 2) drug court with community services (DC), 3) drug court with MST (DC/MST), and 4) drug court with MST enhanced with contingency management (DC/MST/CM). No nontreatment comparison group was included in the study. Assessments were conducted at three points in time: pretreatment, 4 months following treatment, and 12 months following treatment.

Sample youths were on average 15.2 years old and predominantly male (83 percent) and African American (67 percent). Another 31 percent were white, and 2 percent identified as biracial. Youths averaged 3.6 arrests before entering the study. There were no significant differences between groups at pretreatment.

Substance abuse was measured through self-reports and biological indices (drug urine screens from the three drug courts). Because of low positive screens for cocaine and amphetamines, analysis focused solely on cannabis use. Criminal behavior was assessed through self-reports and arrest records. Mental health symptoms were assessed through youth and caregiver reports. Data was analyzed looking at the effects at 12 months following recruitment.

Study 2
Henggeler and colleagues (2012) conducted a randomized experimental design with intent-to-treat analysis to evaluate the impact of JDCs with the contingency management­–family engagement intervention (CM–FAM) on substance abuse and criminal behavior.

Six JDCs were used in the study. Three were randomly selected to receive training and support to implement CM–FAM for 18 months, and the other three were randomly selected to deliver their treatment as usual. Juveniles in JDCs were referred from juvenile justice authorities, family court, or county departments of mental health and social services. For participation, juveniles had to be between 12 and 17 years old, be on formal or informal probationary status, and speak English fluently.

Juveniles in the study did not differ in their demographic or diagnostic characteristics. Participants were, on average, 15.4 years old, mainly male (83 percent), and mostly white (57 percent). Another 40 percent were African American, 3 percent identifying as biracial. Final analyses included data from 104 juveniles, with 63 juveniles in the CM–FAM condition and 41 juveniles in the treatment-as-usual condition.

Juvenile outcomes were measured using self-reported substance use and delinquent behavior at baseline, and at 3, 6, and 9 months after recruitment. Urine drug screens were collected at random times weekly. Self-reported substance use was evaluated using a timeline follow-back methodology for the previous 90 days at the time of survey. Analyses were performed using mixed-effects regression models.
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Cost

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Sheidow and colleagues (2011) conducted a cost-effectiveness analysis of the study by Henggeler and colleagues (2006), which examined the impact of juvenile drug courts with multisystemic therapy and contingency management (DC/MST/CM), compared with traditional family court (FC) and traditional drug court services, (DC) on substance use and criminal behavior. A cost-effectiveness analysis can determine whether the improved outcomes of DC/MST/CM compared with FC and DC are worth the increased expense of treatment. The average cost per case was determined by summing all the program costs (i.e., drug court costs, multisystemic therapy costs, and contingency management costs) and dividing it by the number of cases treated in a year. The analysis showed that the DC/MST/CM group was the most costly approach, with an average treatment cost of $12,994 per case over a 12–month period. The average treatment cost per case for DC with community services was $9,178, while the average cost of treatment for FC was $3,178 per case over 12 months. Results indicated that cost-effectiveness improved with the increasing intensity of interventions used. Although the treatment for DC/MST/CM was the costliest, the study authors argued that the combination of juvenile drug court with evidence-based treatment (i.e., MST and CM) was broadly cost-effective in reducing juvenile offenders’ substance use and delinquent behavior. However, the FC option did affect the juvenile’s marijuana use and theft, and was less costly than the DC and DC/MST/CM options. Although the FC and DC options’ average costs were less than the DC/MST/CM option upfront, the impacts of DC/MST/CM on substance use and criminal behavior translated to a cost-effective return on investment in terms of criminal incidents avoided and costs associated with treating substance use.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Henggeler, Scott W., Colleen A. Halliday–Boykins, Philippe B. Cunningham, Jeff Randall, Steve B. Shapiro, and Jason E. Chapman. 2006. “Juvenile Drug Court: Enhancing Outcomes by Integrating Evidence-Based Treatments.” Journal of Counseling and Clinical Psychology 71(1):42–54.

Study 2
Henggeler, Scott W., Michael R. McCart, Philippe B. Cunningham, and Jason E. Chapman. 2012. “Enhancing the Effectiveness of Juvenile Drug Courts by Integrating Evidence-Based Practices.” Journal of Consulting and Clinical Psychology 80(2):264–75.
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Additional References

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These sources were used in the development of the program profile:

Henggeler, Scott W., Jason E. Chapman, Melisa D. Rowland, Colleen A. Halliday–Boykins, Jeff Randall, Jennifer Shackelford, and Sonja K. Schoenwold. 2008. “Statewide Adoption and Initial Implementation of Contingency Management for Substance Abusing Adolescents.” Journal of Counseling and Clinical Psychology 76(4):556–67.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2603081/

Petry, Nancy M. 2000. “A Comprehensive Guide to the Application of Contingency Management Procedure in Clinical Settings.” Drug and Alcohol Dependence 58(1–2):9–25.


Sheidow, Ashli J., Jayani Jayawardhana, W. David Bradford, Scott W. Henggeler, and Steven B. Shapiro. 2012. "Money Matters: Cost-Effectiveness of Juvenile Drug Court With and Without Evidence-Based Treatments." Journal of Child and Adolescent Substance Abuse 21:69–90.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3290130/
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Related Practices

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Following are CrimeSolutions.gov-rated practices that are related to this program:

Juvenile Drug Courts
Juvenile drug courts are dockets within juvenile courts for cases involving substance abusing youth in need of specialized treatment services. The focus is on providing treatment to eligible, drug-involved juvenile offenders with the goal of reducing recidivism and substance abuse. The practice is rated Promising in reducing recidivism rates, and No Effects for reducing drug-related offenses or drug use.

Evidence Ratings for Outcomes:
Promising - More than one Meta-Analysis Crime & Delinquency - Multiple crime/offense types
No Effects - One Meta-Analysis Crime & Delinquency - Drug and alcohol offenses
No Effects - One Meta-Analysis Drugs & Substance Abuse - Multiple substances
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Program Snapshot

Age: 12 - 17

Gender: Both

Race/Ethnicity: Black, White, Other

Geography: Rural, Suburban

Setting (Delivery): Other Community Setting, Courts

Program Type: Alcohol and Drug Therapy/Treatment, Drug Court, Family Therapy, Individual Therapy, Probation/Parole Services, Wraparound/Case Management, Alcohol and Drug Prevention

Targeted Population: Alcohol and Other Drug (AOD) Offenders

Current Program Status: Active

Listed by Other Directories: Model Programs Guide