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Program Profile: Baltimore City (Md.) Drug Treatment Court

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on June 13, 2011

Program Summary

A court that identifies offenders with substance abuse addiction and offers them a program with treatment rather than incarceration. The program is rated Promising. Participants were significantly less likely to be rearrested and had lower scores of maximum crime seriousness. There was no significant difference between drug court participants and control members with respect to employment, physical and mental health or family and social relationships.

This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Description

Program Goals/Key Personnel

The Baltimore City Drug Treatment Court (BCDTC) in Baltimore, Maryland, was created in 1994 in response to a report by the American Bar Association that found that nearly 85 percent of all crimes committed in Baltimore were addiction driven (Bar Association of Baltimore City 1990). The objective of the BCDTC is to identify offenders with substance abuse addiction and offer them a treatment alternative to incarceration. There are four main goals of the BCDTC:

 

·        Provide pretrial, drug-dependent detainees with close supervision

·        Allow judges to use a cost-effective sentencing option by providing a fully integrated and comprehensive treatment program

·        Reduce recidivism rates of street crime committed by drug-motivated offenders

·        Facilitate the academic, vocational, and prosocial skill development of offenders

 

The drug treatment court team includes a judge, program coordinator, assistant State’s attorney, assistant public defender, parole and probation agents, and treatment providers from Baltimore.

 

Target Population/Eligibility

Potential drug court participants are referred to the program from one of two tracks: circuit court felony cases or district court misdemeanor cases. Participants from both courts are supervised by the Baltimore Division of Parole and Probation. An offender must satisfy several requirements to be eligible for participation in BCDTC. Offenders must first admit to substance use and/or show evidence of past substance use charges. They must also reside in Baltimore, be at least 18 years of age, and not have any prior or current convictions for violent offenses.

 

Eligible offenders meet with the public defender to discuss potential participation. If the public defender and State’s attorney determine the offender is best served by drug treatment court, the offender is sent to the drug court assessment unit. Staff members from this unit administer the Level of Supervision Inventory – Revised (or LSI–R) and Addiction Severity Index (or ASI) to assess the offender’s suitability for the program, and motivation and need for treatment. Once the assessment is complete, the unit staff member decides whether to recommend the offender for the program. If recommended, the offender, State’s attorney, public defender, and probation agent appear before the drug treatment court judge to discuss the case. The judge ultimately renders the final decision of whether an offender will participate in the program.

 

Program Components

The BCDTC program consists of four main elements: intensive probation supervision, drug testing, drug treatment, and judicial monitoring. While under intensive supervision, offenders must adhere to three face-to-face meetings with their probation officer per month, two home-visits, and verification of employment status. Probation officers also frequently monitor an offender’s criminal record for violations. After a sustained period of compliance, an offender’s level of supervision can be downgraded from “intensive” to “standard high.”

 

Drug testing is also performed in a series of phases of decreasing intensity. Phase I, which lasts approximately 3 weeks, requires offenders to submit to two urine samples per week. Phase II, which also lasts about 3 months, requires one sample per week. Phase III, lasting about 6 months in length, requires only one sample per month. After that time, drug testing is completed randomly throughout the remaining time an offender is in drug treatment court.

 

Drug treatment is provided by several providers throughout the city. Each treatment program varies in terms of treatment components. The providers include intensive outpatient centers, methadone maintenance clinics, residential treatment facilities, and a transitional housing complex. In addition to drug treatment, each program offers educational opportunities, job training, life-skills training, and housing assistance. Offenders are assigned to a program that best serves their treatment needs.

 

Finally, judicial monitoring takes place in the form of frequent status hearings. The judge reviews reports from treatment providers and probation officers at these hearings to determine an offender’s compliance with the program. Failure to comply with program requirements can result in a variety of sanctions, including increased status hearings, increased drug testing, and curfews. The sanctions can graduate to more severe measures such as home detention, temporary incarceration, and community service. If an offender displays extreme noncompliance with the program, the judge can reimpose the original sentence, which can often be more severe than if the sentence had been imposed under traditional adjudication.

 

To graduate from the program, offenders must be employed, have completed 20 hours of community service, have participated in the program for a minimum of 12 months, and have at least 9 months of clean urine samples.

Evaluation Outcomes

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Study 1

Recidivism

Gottfredson, Najaka, and Kearley (2003) found that participants in the Baltimore City Drug Treatment Court (BCDTC) in Baltimore, MD, were significantly less likely than the control group to be rearrested. Specifically, 66.2 percent of BCDTC participants were rearrested, compared to 81.3 percent of the control group. The number of new arrests (1.6 versus 2.3) and new charges (3.1 versus 4.6) were also significantly lower for drug court participants than for control group members. Once rearrested, however, drug treatment court participants were as likely as control group members to be reconvicted.

 

The most common type of offense for which study participants were rearrested was drug offenses, followed by public order and property offenses. BCDTC participants were far less likely to be rearrested for drug offenses compared to the control group (40.6 percent compared to 54.2 percent, respectively).

 

Study 2

Criminal Activity and Drug Use, Treatment as Assigned

In the intent-to-treat analyses, Gottfredson and colleagues (2005) found that although 49.5 percent of drug court participants self-reported being arrested in the year prior to their follow-up interview versus 57.8 percent of the control group members, the difference was not statistically significant. Drug court participants did have significantly lower scores on the measure of maximum crime seriousness compared to the control group (1.1 versus 1.9, respectively), suggesting the most serious crime committed by members of the control group were significantly more serious than for the treatment group. Drug court participants also committed significantly fewer different types of crime than control group members, as measured by the crime variety scale (0.07 versus 0.11, respectively). When looking at the originating court, however, there was only a significant difference in the measure of crime variety for drug court participants in the circuit court—and not for participants in the district court.

 

Drug court participants used significantly fewer different types of drugs than control participants, as measured by the drug variety scale (0.14 versus 0.18, respectively), and they scored significantly lower on the alcohol addiction severity scale (1.2 versus 1.4). Again, there were differences in outcomes based on the originating court of participants. Drug court participants had significantly fewer days of cocaine use and lower scores on the drug addiction severity scale compared to control group members, but only for participants from the circuit court.

 

Criminal Activity and Drug Use, Treatment as Received

There were significant differences between study participants that received treatment and participants who did not receive treatment (regardless of their randomly assigned condition). All of the significant differences found in the intent-to-treat analyses remained significant. Additional significant differences were found in the percent of participants arrested (43 percent of participants who received treatment versus 64.8 percent who did not receive treatment) and in measures of heroin use, drug addiction severity, alcohol use, and cocaine use.

  

Employment

There was no significant difference between drug court participants and control group members in the percentage of participants who were employed at the time of the interviews. The percentage of drug court participants who received money from welfare was 4.3, compared to 10.9 percent of control participants, but this difference was not significant.

 

Physical and Mental Health

There were no significant differences between drug court participants and control group members on measures of physical and mental health.

 

Family and Social Relationships

There was also no significant difference between drug court participants and control participants on measures of family and social relationships.

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Evaluation Methodology

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Study 1
Gottfredson, Najaka, and Kearley (2003) used an experimental design to test the effectiveness of the Baltimore City Drug Treatment Court (BCDTC), in Baltimore, MD, to reduce crime in a population of offenders who are severely drug addicted. The study looked at the outcome results of 235 offenders randomly assigned to BCDTC or treatment as usual from February 1997 to August 1998 over a 2-year follow-up period. The subjects were followed for three years. This study looked at a 2-year follow-up period, while the results from the three-year follow-up were analyzed and discussed in the 2005 study (described below) and a 2006 study by Gottfredson and colleagues.

The treatment group included 139 offenders; they were 89.2 percent African American, 74.1 percent male, and an average of 34.8 years in age. The control group, which received treatment as usual, consisted of 96 offenders who were 89.6 percent African American, 74 percent male, and an average of 34.7 years in age. There were no statistically significant differences between the groups. Although offenders were randomly assigned, records indicate only 91 percent of the treatment group were actually dealt with in the BCDTC, while 7 percent of the control group assigned to treatment as usual were dealt with in the drug treatment court. The reasons for the misassignments of cases are not known, but may be because of judicial overrides of the randomization process and clerical errors. The study used intent-to-treat analysis, which means study participants were treated as randomized, regardless of their actual treatment. This strategy was adopted to preserve the comparability of study groups.

Data was collected from the Maryland Department of Public Safety and Correctional Services and the Baltimore Substance Abuse Services, an organization that coordinates drug treatment services in Baltimore. The main outcome of interest was recidivism, which was measured as rearrests, reconvictions, new arrests, new charges, and new convictions over the 24-month period following the date of randomization. The study used chi-square tests and t-tests to compare the drug treatment court participants to control group members. Analysis of variance (or ANOVA) was also used to test for interaction effects between the experimental condition (drug court or control) and originating court (district or circuit).

Study 2
A 2005 follow-up study by Gottfredson, Kearley, Najaka, and Rocha assessed the effectiveness of BCDTC in improving criminal activity, substance use, welfare status, employment status, mental health, physical health, and family and social relationships. This study looked at 157 participants who were interviewed 3 years after being randomly assigned to either drug treatment court or treatment as usual, including 72 percent of drug court participants and 70 percent of control group members. The study sample was 74 percent male and 89 percent African American, with an average age of 34.8 years. There were no statistically significant differences between the interviewed group and the noninterviewed group, except on recidivism. During the 3-year follow-up, the group of study participants that was interviewed had more arrests compared to the study participants that were not interviewed, reflecting the fact that jails and prisons were reliable locations to find individuals that were otherwise difficult to track.

Study participants from the 2003 study were contacted by mail using an address provided by the Division of Parole and Probation. For nonresponders, attempts were made to reach them by phone (using telephone directory assistance, reverse directories, and local phone books) or home visits. There were additional attempts to find study participants by searching social service agencies, vital statistics records, official and commercial databases, and the Maryland Motor Vehicle Administration. When necessary, homeless shelters, high drug area “hangouts,” and community treatment centers were also searched.

The outcome measures of interest include drug use, criminal activity, mental and physical health, family and social relationships, education, and employment. The interview instrument combined single items and scales from existing surveys used in prior evaluations of drug treatment courts, including the Addiction Severity Index (ASI), the High-Intensity Drug Trafficking Area Life Events Survey, and the Brief Symptom Inventory (BSI). Criminal activity was measured using two scales: the maximum crime seriousness scale and the crime variety scale. Alcohol and drug use was measured using three scales, including the alcohol addictions severity scale, the drug addiction severity scale, and the drug variety scale. The ASI family and social relationships scale measured a study participant’s level of conflict with friends, family, neighbors, and coworkers in the past 30 days. The scale also asked participants about family problems in the past 30 days, whether they were bothered by those problems, and if they were interested in treatment. The ASI medical status scale asked study participants about the number of days of medical problems in the past 30 days, whether they were bothered by those problems, and if they were interested in treatment. Finally, the BSI global mental health severity scale measured a participant’s current level of symptomatology relating to a host of psychological disorders, including somatization, obsession–compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. All scales had an alpha reliability ranging from 0.65 to 0.97.

The data analysis used chi-square tests and t-tests to compare the drug court and control group members. Analysis of variance (or ANOVA) was also used to test for interaction effects between the experimental condition (drug court or treatment as usual) and the originating court (district or circuit court). A one-tailed significance test was employed to balance the concerns of making a Type I error with the equal concern of making a Type II error. In instances in which multiple tests were conducted on a single measurement (i.e., criminal activity and drug use), a Bonferroni adjustment was performed. In each instance, the alpha level of .10 was divided by the number of correlated variables.

In the first set of analyses, study participants were treated as randomized, regardless of their actual treatment. So participants who were randomly assigned to the drug court group were analyzed as members of the treatment group regardless of whether they actually participated in court or not. A second set of analyses was conducted using variables that captured the actual treatment participants received.
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Cost

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NPC Research (2009) performed a cost evaluation of the Baltimore (Md.) City Drug Treatment Court (BCDTC), using an approach called Transactional and Institutional Cost Analysis (or TICA). This approach views an individual’s interaction with agencies that receive public funding as a set of transactions in which the individual uses resources contributed from multiple agencies. Transactions are those points in a system where resources are consumed and/or change hands. In this analysis, outcome costs were calculated for rearrests, subsequent court cases, jail time, prison time, and probation/parole time. Only costs to taxpayers were calculated, using fiscal year 2009 dollars. The cost evaluation compared the outcome costs for BCDTC participants (n=694), including those that graduated from the program (n=193), to a comparison group that did not participate in drug treatment court (n=860) over a 10-year period. The evaluation found average criminal justice system outcome costs were 4.8 percent lower for BCDTC participants ($61,756) after 10 years than comparison group members ($64,701). This results in a total cost savings of $2,945 per participant over 10 years (or $294.50 per participant per year), regardless of whether the participant graduates from the program or not. If the BCDTC continues to admit a cohort of 200 new participants each year, this leads to an average yearly savings of $58,900 per cohort. After 10 years, the savings for one cohort of program participants totals $589,000. BCDTC participants that graduated from the program have costs of $18,494 after 10 years, which is 250 percent lower than comparison group members. That results in a cost savings of $46,207 per graduate when compared to comparison group members over 10 years. The results show that successful completion of BCDTC can lead to significant outcome cost savings.
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Other Information (Including Subgroup Findings)

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CrimeSolutions.gov reviewers reviewed multiple studies for this program. The reviewers found that the evidence for positive program outcomes was not consistent in all studies reviewed. Therefore, the single study icon is used. Promising programs have some evidence indicating they achieve their intended outcomes. Additional research is recommended.
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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
Gottfredson, Denise C., Stacy S. Najaka, and Brook Kearley. 2003. “Effectiveness of Drug Treatment Courts: Evidence From A Randomized Trial.” Criminology & Public Policy 2(2):171–96.

Study 2
Gottfredson, Denise C., Brook W. Kearley, Stacy S. Najaka, and Carlos M. Rocha. 2005. “The Baltimore City Drug Treatment Court: 3-Year Self-Report Outcome Study.” Evaluation Review 29(1):42–64.
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Additional References

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

Banks, Duren, and Denise C. Gottfredson. 2003. “The Effects of Drug Treatment and Supervision on Time to Rearrest Among Drug Treatment Court Participants.” Journal of Drug Issues 33:385–412.

Banks, Duren, and Denise C. Gottfredson. 2004. “Participation in a Drug Treatment Court and Time to Re-Arrest.” Justice Quarterly 21(3):637–58.

Bar Association of Baltimore City. 1990. The Drug Crisis and Underfunding of the Justice System in Baltimore City. Baltimore, Md.: Report of the Russell Committee 9.

Gottfredson, Denise C. and M. Lyn Exum. 2002. “The Baltimore City Drug Treatment Court: One-Year Results from a Randomized Study.” Journal of Research in Crime and Delinquency 39:337–56.

Gottfredson, Denise C., Stacy S. Najaka, Brook Kearley, and Carlos M. Rocha. 2006. “Long-Term Effects of Participation in the Baltimore City Drug Treatment Court: Results from an Experimental Study.” Journal of Experimental Criminology 2:67–98.

Gottfredson, Denise C., Brook W. Kearley, Stacy S. Najaka, and Carlos M. Rocha. 2007. “How Drug Treatment Courts Work: An Analysis of Mediators.” Journal of Research in Crime and Delinquency 44(1):3–35.

Mackin, Juliette R., Lisa M. Lucas, Callie H. Lambarth, Mark S. Waller, Judy M. Weller, Jennifer A. Aborn, Robert Linhares, Theresa L. Allen, Shannon M. Carey, and Michael W. Finigan. 2009. Baltimore City District Court Adult Drug Treatment Court: 10-Year Outcome and Cost Evaluation. Portland, Ore.: NPC Research.
http://www.npcresearch.com/Files/Baltimore_City_District_10_Year_Outcome_Cost_0609.pdf
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Related Practices

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

Adult Drug Courts
Drug courts are specialized courts that combine drug treatment with the legal and moral authority of the court in an effort to break the cycle of drug use and drug related crime. The practice was rated Promising for reducing recidivism; Promising for reducing alcohol and drug-related offenses (with a 13 percent lower rate compared to nonparticipants); but No Effects for reducing multiple substance use.

Evidence Ratings for Outcomes:
Promising - More than one Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Promising - 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: 18+

Gender: Both

Race/Ethnicity: Black, Hispanic, White

Geography: Urban

Setting (Delivery): Inpatient/Outpatient, Other Community Setting, Courts

Program Type: Alcohol and Drug Therapy/Treatment, Alternatives to Incarceration, Drug Court, Individual Therapy, Probation/Parole Services, Residential Treatment Center

Targeted Population: Alcohol and Other Drug (AOD) Offenders

Current Program Status: Active

Listed by Other Directories: Campbell Collaboration

Researcher:
Denise Gottfredson
Department of Criminology and Criminal Justice
University of Maryland
2220 LeFrak Hall
College Park MD 20742
Phone: 301.405.4717
Fax: 301.405.4733
Email