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History and Data on Juvenile Treatment Drug Courts

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Title: History and Data on Juvenile Treatment Drug Courts


1
History and Data on Juvenile Treatment Drug
Courts
  • Michael L. Dennis, Ph.D.
  • Chestnut Health Systems
  • Normal, IL
  • Presentation at the Center for Substance Abuse
    Treatment (CSAT)
  • Juvenile Treatment Drug Court (JTDC) Orientation
    Meeting,
  • Baltimore, MD, December 13, 2010. This
    presentation was supported by data and funds from
    SAMHSA/ CSAT contract no. 270-07-0191. It is
    available electronically at www.chestnut.org/li/po
    sters. The opinions are those of the author and
    do not reflect official positions of the
    government. Please address comments or questions
    to the author at mdennis_at_chestnut.org or
    309-451-7801.

2
The Goals of this Presentation are to
  1. Illustrate why it is so important to intervene
    with juvenile drug users
  2. Review what we know about juvenile treatment drug
    courts (JTDC) so far
  3. Compare JTDC to regular adolescent outpatient
    (AOP) in terms of who is served, what services
    they receive and their treatment outcomes
  4. Examine other lessons from juvenile justice and
    adolescent treatment studies to date.

3
Alcohol and Other Drug Abuse, Dependence and
Problem Use Peaks at Age 20
100
People with drug dependence die an average of
22.5 years sooner than those without a diagnosis
90
Percentage
80
70
60
Severity Category
50
Other drug or heavy alcohol use in the past year
40
30
Alcohol or Drug Use (AOD) Abuse or Dependence
in the past year
20
10
0
65
12-13
14-15
16-17
18-20
21-29
30-34
35-49
50-64
Age
Source 2002 NSDUH and Dennis Scott, 2007,
Neumark et al., 2000
4
Adolescents who use weekly or more often are more
likely during the past year to have ..
  • Source Dennis, White Ives, 2009

5
Adolescent Brain Development Occurs from the
Inside to Out and from Back to Front
Photo courtesy of the NIDA Web site. From A Slide
Teaching Packet The Brain and the Actions of
Cocaine, Opiates, and Marijuana.
6
Prolonged Substance Use Injures The Brain
Healing Takes Time
Normal levels of brain activity in PET scans show
up in yellow to red
Normal
Reduced brain activity after regular use can be
seen even after 10 days of abstinence
10 days of abstinence
After 100 days of abstinence, we can see brain
activity starting to recover
100 days of abstinence
Source Volkow ND, Hitzemann R, Wang C-I, Fowler
IS, Wolf AP, Dewey SL. Long-term frontal brain
metabolic changes in cocaine abusers. Synapse
11184-190, 1992 Volkow ND, Fowler JS, Wang G-J,
Hitzemann R, Logan J, Schlyer D, Dewey 5, Wolf
AP. Decreased dopamine D2 receptor availability
is associated with reduced frontal metabolism in
cocaine abusers. Synapse 14169-177, 1993.
7
Other Life Course Reasons to Focus on Adolescents
  • People who start using under age 15 use 60 more
    years than those who start over age 18
  • Entering treatment within the first 9 years of
    initial use leads to 57 fewer years of substance
    use than those who do not start treatment until
    after 20 years of use
  • Relapse is common and it takes an average of 3 to
    4 treatment admissions over 8 to 9 years before
    half reach recovery
  • Of all people with abuse or dependence 2/3rds do
    eventually reach a state of recovery
  • Monitoring and early re-intervention with adults
    has been shown to cut the time from relapse to
    readmission by 65, increase abstinence and
    improve long term outcomes

Source Dennis et al., 2005, 2007 Scott
Dennis 2009
8
What Is Treatment?
  • Motivational interviewing and other protocols to
    help them understand how their problems are
    related to their substance use and that they are
    solvable
  • Detoxification and medication to reduce pain/risk
    of withdrawal and relapse, including tobacco
    cessation
  • Evaluation of antecedents and consequences of use
  • Group, individual or family outpatient including
    relapse prevention planning
  • More systemic family approaches
  • Proactive urine monitoring
  • Motivational incentives / contingency management
  • Residential, intensive outpatient (IOP) and other
    types of structured environments to reduce short
    term risk of relapse
  • Access to communities of recovery for long term
    support, including 12-step, recovery coaches,
    recovery schools, recovery housing, workplace
    programs
  • Continuing care, phases for multiple admission

9
While Substance Use Disorders are Common,
Treatment Participation Rates Are Low
Over 88 of adolescent and young adult treatment
and over 50 of adult treatment is publicly
funded
Much of the private funding is limited to 30 days
or less and authorized day by day or week by week
Source OAS, 2009 2006, 2007, and 2008 NSDUH
10
Other Problems With the U.S. Treatment System
  • Less than 75 stay the 90 days recommended by
    NIDA (half less than 50 days)
  • Less than half are positively discharge
  • Less than 10 leaving higher levels of care are
    transferred to outpatient continuing care
  • The majority of programs do NOT use standardized
    assessment, evidenced based treatment, track the
    clinical fidelity of the treatment they provide
    or monitor their own performance in terms of
    client outcomes
  • Average staff education is an Associate Degree
  • Staff stay on the job an average of 2 years

11
What does an episode of treatment cost?
  • 750 per night in Detox
  • 1,115 per night in hospital
  • 13,000 per week in intensive
  • care for premature baby
  • 27,000 per robbery
  • 67,000 per assault

22,000 / year to incarcerate an adult
70,000/year to keep a child in detention
30,000/ child-year in foster care
Source French et al., 2008 Chandler et al.,
2009 Capriccioso, 2004
12
Investing in Treatment has a Positive Annual
Return on Investment (ROI)
  • Substance abuse treatment has been shown to have
    a ROI within the year of between 1.28 to 7.26
    per dollar invested
  • Best estimates are that Treatment Drug Courts
    have an average ROI of 2.14 to 2.71 per dollar
    invested

This also means that for every dollar treatment
is cut, we lose more money than was saved.
Source Bhati et al., (2008) Ettner et al.,
(2006)
13
Background Juvenile Justice System and Substance
Use
  • About half of the youth in the juvenile justice
    system have drug related problems (Office of
    Juvenile Justice and Delinquency Prevention
    (OJJDP), 2001 Teplin et al., 2002).
  • Juvenile justice systems are the leading source
    of referral among adolescents entering treatment
    for substance use problems (Dennis et al., 2003
    Dennis, White Ives, 2009)
  • By late 2004, there were 357 juvenile treatment
    drug courts and the number of courts has
    continued to grow at a rate of 30-50 per year.

Source Dennis, White Ives, 2009
14
What are the Recommended Components of a
Juvenile Treatment Drug Court?
  1. Formal Screening Process for early identification
    and referral for substance use and other
    disorders/needs
  2. Multidimensional standardized assessment to guide
    clinical decision making related to diagnosis,
    treatment planning, placement and outcome
    monitoring
  3. Interdisciplinary treatment drug court team
  4. Comprehensive non-adversarial team-developed
    treatment plan, including youth and family
  5. Continuum of substance-abuse treatment and other
    rehabilitative services to address the youths
    needs
  6. Use of Evidenced Based Treatment Practices

Source Adapted from Henggeler (2007) and the
National Association of Drug Court Professionals
(NADCP, 1997) principals for drug court.
15
What are the Recommended Components of a Juvenile
Treatment Drug Court? (continued)
  1. Monitoring progress through urine screens and
    weekly interdisciplinary treatment drug court
    team staffings
  2. Feedback to the judge followed by graduated
    performance-based rewards and sanctions
  3. Reducing judicial involvement from weekly to
    monthly with evidence of favorable behavior
    change over a year or longer
  4. Advanced agreement between parties on how on
    assessment information will be used to avoid self
    incrimination
  5. Use of information technology to connect parties
    and proactively monitor implementation at the
    client and program level

Source Adapted from Henggeler (2007) and the
National Association of Drug Court Professionals
(NADCP, 1997) principals for drug court.
16
What Level of Evidenced is Available on the
Effectiveness of Drug Courts?
Science
Law
Meta Analyses of Experiments/ Quasi Experiments
(Summary v Predictive, Specificity, Replicated,
Consistency) Dismantling/ Matching study (What
worked for whom) Experimental Studies
(Multi-site, Independent, Replicated, Fidelity,
Consistency) Quasi-Experiments (Quality of
Matching, Multi-site, Independent, Replicated,
Consistency) Pre-Post (multiple waves), Expert
Consensus Correlation and Observational
studies Case Studies, Focus Groups Pre-data
Theories, Logic Models Anecdotes, Analogies
STRONGER
Beyond a Reasonable Doubt
Clear and Convincing Evidence
Preponderance of the Evidence
Probable Cause
Reasonable Suspicion
Source Marlowe 2008
17
What Level of Evidenced is Available on the
Effectiveness of Drug Courts?
Science
Law
Meta Analyses of Experiments/ Quasi Experiments
(Summary v Predictive, Specificity, Replicated,
Consistency) Dismantling/ Matching study (What
worked for whom) Experimental Studies
(Multi-site, Independent, Replicated, Fidelity,
Consistency) Quasi-Experiments (Quality of
Matching, Multi-site, Independent, Replicated,
Consistency) Pre-Post (multiple waves), Expert
Consensus Correlation and Observational
studies Case Studies, Focus Groups Pre-data
Theories, Logic Models Anecdotes, Analogies
STRONGER
Beyond a Reasonable Doubt
Adult Drug Treatment Courts 5 meta analyses of
76 studies found crime reduced 7-26 with 1.74
to 6.32 return on investment
Clear and Convincing Evidence
DWI Treatment Courts one quasi experiment and
five observational studies positive findings
Preponderance of the Evidence
Family Drug Treatment Courts one multisite
quasi experiment with positive findings for
parent and child
Probable Cause
Juvenile Drug Treatment Courts one 2006
experiment, one in press large multisite
quasi-experiment, several small studies with
similar or better effects than regular adolescent
outpatient treatment
Reasonable Suspicion
Source Marlowe 2008
18
Juvenile Treatment Drug Court Effectiveness
  • Low levels of successful program completion among
    youths in drug courts was noticeable in several
    early studies (Applegate Santana, 2000 Miller,
    Scocas OConnell, 1998 Rodriguez Webb, 2004)
  • Youths in drug court treatment were no more
    likely to recidivate over a two-year post-release
    period than youths being treated in an adolescent
    substance abuse treatment program (Sloan, Smykla
    Rush, 2004).
  • In a randomized controlled trial, a JTDC was
    found to be more effective than traditional
    family court with community service in reducing
    adolescent substance abuse (particularly when
    using evidence-based treatment) and criminal
    involvement during treatment (Henggeler, et al.,
    2006)

19
Change in Substance Use By Condition
Family Court w community service
Drug Court (d0.8)
Drug Court plus Multi-Systemic Therapy (MST)
(d1.4)
Drug Court plus MST contingency Management
(d1.6)
Pre-Intake
4 months
12 months
Source Henggeler et al 2006
p lt .05
20
Change in General Delinquency By Condition
Family Court w community service
Drug Court plus MST contingency Management (d0.
80)
Drug Court plus Multi-Systemic Therapy
(MST) (d0.80)
Drug Court (d0.90)
Pre-Intake
4 months
12 months
Source Henggeler et al 2006
p lt .05
21
Strengths Limits of Henggeler et al 2006
  • Strengths
  • Random assignment
  • Replicable evidenced based practice
  • High fidelity implementation
  • Multiple follow-up waves
  • Self report, urine test records
  • Limits
  • Single site
  • Small sample size (29-37 per condition)
  • Differences at intake in spite of randomization
  • Variation in findings by outcome measure

22
Findings from Ives et al (in press) Multi-Site
Quasi Experiment
  • How do the severity needs of youth in Juvenile
    Treatment Drug Courts (JTDC) compare to those
    Adolescent Outpatient (AOP)
  • Controlling for these differences, how do they
    compare in terms of
  • The services they receive?
  • Their treatment outcomes?

23
Juvenile Treatment Drug Court (JTDC) Sample
  • Cohort of 13 CSAT JTDC grantee sites using the
    GAIN in Laredo, TX, San Antonio, TX, Belmont, CA,
    Tarzana, CA, Pontiac, MI, Birmingham, AL, San
    Jose, CA, Austin, TX, Peabody, MA, Providence,
    RI, Detroit, MI, Philadelphia, PA, and Basin, WY.
  • Intake data collected from these sites on N1,786
    adolescents between January 2006 through March
    31, 2009.
  • The records were limited to clients who
  • Received outpatient treatment (N1,445), and
  • Had attained 6 months post-intake (N1,265)
  • For the analysis, only those with at least one
    follow-up assessment (89) were used for a final
    N1,120
  • 86 received evidence-based treatment

Source Ives et al., in press
24
Adolescent Outpatient (AOP) Sample
  • Clients receiving AOP treatment from 75
    CSAT-funded sites using the GAIN and providing
    outpatient treatment in 29 states from five grant
    programs (N10,037).
  • Intake data collected from these sites on
    n10,037 adolescents between September 2002 and
    August 2008.
  • The records were limited to clients who
  • Received outpatient treatment (all), and
  • Had attained 6 months post-intake (N8,604)
  • For the analysis, only those with at least one
    follow-up assessment (88) were used for a final
    N7,560
  • 93 received evidence-based treatment.

JTDC AOP were significantly different on 36 of
69 measures of characteristics, severity and
treatment need
Source Ives et al., in press
25
Demographics
JTDC less likely to be Caucasian, older,
employed, in trouble at school/work more
likely to be Hispanic/ Mixed, Behind in school,
Source Ives et al., in press
plt.05
26
Crime and Violence
JTDC more likely have been in a controlled
environment 13 days, engaged in illegal activity
(overall drug related)
Source Ives et al., in press
plt.05
27
Intensity of Juvenile Justice System Involvement
JTDC more likely to be in other JJ status and
less likely to have no JJ status
Source Ives et al., in press
plt.05
28
Environmental Risk Factors
JTDC less likely to have use in home and
victimization
Source Ives et al., in press
plt.05
29
Substance Use
JTDC more likely to have started sooner, use more
often and to use marijuana Less likely to use
tobacco
Source Ives et al., in press
plt.05
30
Substance Use Disorders
JTDC similar on substance use disorders
Source Ives et al., in press
plt.05
31
Substance Treatment History
JTDC more likely to have been in treatment before
and to be ready to quit
plt.05
Source Ives et al., in press
32
Other Major Co-Occurring Clinical Problems
JTDC less likely to have health or internalizing
disorders
plt.05
Source Ives et al., in press
33
HIV Risk Behaivors (past 90 days)
Source Ives et al., in press
plt.05
34
Number of Major Clinical Problems
Count of marijuana use disorder, alcohol use
disorder, any other drug use disorder,
internalizing problems including depression,
anxiety, homicidal/suicidal thoughts, and trauma,
externalizing problems including conduct disorder
and ADHD, Lifetime victimization, past year acts
of physical violence or past year illegal
activity.
JTDC slightly less severe on psychopathology
relative to waiting for them to come on their
own, it is a form of early intervention
plt.05
Source Ives et al., in press
35
Matching with Propensity Scores
  • Using logistic regression to predict the
    likelihood (propensity) of each AOP client being
    a JTDC client based on the 69 intake
    characteristics, we weighted the AOP group to
    match the JTDC group in terms of these
    characteristics and sample size.
  • This produced two groups with equal sample sizes
    (n1,120) and reduced the number of significant
    differences from 39 to 3 Of 69 intake variables
  • Those in JTDC were still significantly
  • Less likely to be African American (OR0.77)
  • More likely to be Hispanic (OR1.44) and on other
    probation, parole, or detention (OR1.37)

Source Ives et al., in press
36
Treatment System Involvement
JTDC less likely to initiate within 2 weeks, but
more likely to be in treatment 6 weeks and 3
months later.
Source Ives et al., in press

p lt.05
37
Substance Abuse Treatment (intake to 3 months)
JTDC received more days of any treatment IOP,
also more satisfaction
Source Ives et al., in press

p lt.05
38
Range of Substance Abuse Treatment
Content (Intake to 3 months)
JTDC more likely to receive a broader range of
services particularly family and external wrap
around services
Source Ives et al., in press

p lt.05
39
Mental Health Treatment Received (intake to 3
months)
Source Ives et al., in press

p lt.05
40
Other Environmental Inteventions Across Systems
(intake to 3 months)
JTDC received more urine tests and went to self
help more often
Source Ives et al., in press

p lt.05
41
Comparison of Treatment Outcomes (Days of ..)
Others Outcomes Not Significantly Different
Post-Pre d (AOP, JTDC)
Illegal Activity (d-0.11, -0.02)
Substance Use ( d-0.45, -0.57)
Emotional Problems (d-0.32, -0.22)
Trouble w/ Family (d -0.23, -0.18)
In Controlled Environment (d-0.02, -0.08)
Source Ives et al., in press
plt.05 change greater for
JTDC vs AOP (d-0.24)
42
Strengths Limits of Ives et al in press
  • Strengths
  • Multisite quasi assignment
  • Differences at intake eliminated on most
    variables
  • Replicable evidenced based practice
  • Multiple follow-up waves
  • Large sample size and high follow-up rates
  • Limits
  • Not randomized
  • Disproportionately Hispanic youth
  • Unknown fidelity of implementation
  • Not sufficient numbers of specific evidenced
    based practices to compare

43
Major Predictors of Bigger Effects Found in
Multiple Meta Analyses (Lipsey, 1997, 2005)
  • A strong intervention protocol based on prior
    evidence
  • Quality assurance to ensure protocol adherence
    and project implementation
  • Proactive case supervision of individual
  • Triage to focus on the highest severity subgroup

44
Impact of the numbers of these Favorable features
on Recidivism in 509 Juvenile Justice Studies in
Lipsey Meta Analysis
The more features, the lower the recidivism
Average Practice
Source Adapted from Lipsey, 1997, 2005
45
Evidenced Based Treatment (EBT) that Typically
do Better than Usual Practice in Reducing
Juvenile Use Recidivism
  • Adolescent Community Reinforcement Approach
    (A-CRA)
  • Aggression Replacement Training (ART)
  • Assertive Continuing Care (ACC)
  • Cognitive Behavior Therapy (CBT)
  • Functional Family Therapy (FFT)
  • Moral Reconation Therapy (MRT)
  • Thinking for a Change (TFC)
  • Interpersonal Social Problem Solving (ISPS)
  • Motivational Enhancement Therapy/Cognitive
    Behavior Therapy (MET/CBT)
  • Motivational Interviewing (MI)
  • Multi Systemic Therapy (MST)
  • Multidimensional Family Therapy (MDFT)
  • Reasoning Rehabilitation (RR)
  • Seven Challenges (7C)

Small or no differences in mean effect size
between these brand names
Source Adapted from Lipsey et al 2001, 2010
Waldron et al, 2001, Dennis et al, 2004
46
Cannabis Youth Treatment (CYT) Similarity of
Clinical Outcomes
Not significantly different by condition.
Trial 1
Trial 2
300
50
.
280
40
.
260
30
over 12 months
at Month 12
Total days abstinent
Percent in Recovery
240
20
220
10
200
0
MET/ CBT5
MET/
FSN
MET/ CBT5
ACRA
MDFT
(n102)
CBT12
(n102)
(n99)
(n100)
(n99)
269
256
260
251
265
257
Total Days Abstinent
0.28
0.17
0.22
0.23
0.34
0.19
Percent in Recovery
n.s.d., effect size f0.06
n.s.d., effect size f0.06
n.s.d., effect size f0.12
n.s.d., effect size f0.16
Source Dennis et al., 2004
47
Moderate to large differences in
Cost-Effectiveness by Condition
Trial 2
Trial 1
20
20,000
16
16,000
12
12,000
Cost per person in recovery
at month 12
over 12 months
Cost per day of abstinence
8
8,000
4
4,000
0
0
MET/
MET/ CBT5
MET/ CBT5
FSN
ACRA
MDFT
CBT12
4.91
6.15
15.13
9.00
6.62
10.38
CPDA
CPPR
3,958
7,377
15,116
6,611
4,460
11,775
plt.05 effect size f0.48
plt.05 effect size f0.22
plt.05, effect size f0.72
plt.05, effect size f0.78
Source Dennis et al., 2004
48
Evidenced Based Practices Can be SIMPLE On-site
proactive urine testing can be used to reduce
false negatives by more than half
49
Implementation is Essential (Reduction in
Recidivism from .50 Control Group Rate)
Thus one should optimally pick the strongest
intervention that one can implement well
Source Adapted from Lipsey, 1997, 2005
50
Percentage Change in Abstinence (6 mo-Intake) by
level of Adolescent Community Reinforcement
Approach (A-CRA) Quality Assurance
Effects associated with Coaching, Certification
and Monitoring (OR7.6)
Source CSAT 2008 SA Dataset subset to 6 Month
Follow up (n1,961)
50
51
Progressive Continuum of Measurement (common
measures)
  • Screening to identify who needs to be assessed
    (5-10 min)
  • Focus on brevity, simplicity for administration
    scoring
  • Needs to be adequate for triage and referral
  • GAIN Short Screener for SUD, MH, and crime
  • ASSIST, AUDIT, CAGE, CRAFT, DAST, MAST for SUD
  • SCL, HSCL, BSI, CANS for mental health
  • LSI, MAYSI, YLS for crime
  • Quick assessment for targeted referral (20-30
    min)
  • Assessment of who needs a feedback, brief
    intervention, or referral for more specialized
    assessment or treatment
  • Needs to be adequate for brief intervention
  • GAIN Quick
  • ADI, ASI, SASSI, T-ASI, MINI
  • Comprehensive biopsychosocial (1-2 hours)
  • Used to identify common problems and how they are
    interrelated
  • Needs to be adequate for diagnosis, treatment
    planning, and placement of common problems
  • GAIN Initial (Clinical Core and Full)
  • CASI, A-CASI, MATE
  • Specialized assessment (additional time per area)
  • Additional assessment by a specialist (e.g.,
    psychiatrist, MD, nurse, spec. ed.) may be needed
    to rule out a diagnosis or develop a treatment
    plan or individual education plan

Screener Quick
Comprehensive Special
More Extensive / Longer / Expensive
52
Any Illegal Activity can be better predicted by
using Intake Severity on Crime/Violence and
Substance Problem Scales
While there is risk, most (42-80) actually do
not commit additional crime
Source CSAT 2008 V5 dataset Adolescents aged
12-17 with 3 and/or 6 month follow-up (N9006)
53
Outcomes May be Hidden by Multi-Dimensional
Subgroups Example of HIV Risk Outcomes
0.40
0.20
0.00
-0.02
-0.03
-0.10
Cohen's Effect Size d
-0.20
-0.40
Unprotected Sex Acts (f.14)
Days of Victimization (f.22)
-0.60
Days of Needle Use (f1.19)
-0.80
A.
B.
C.
D.
Total
Low Risk
Mod. Risk W/O Trauma
Mod. Risk
High Risk
With Trauma
Source Lloyd et al 2007
54
Longer Assessments Identify More Areas of Need
Most substance users have multiple problems
54
5 min.
20 min
30 min
1-2 hr
Source Reclaiming Futures Portland, OR and Santa
Cruz, CA sites (n 192)
55
Multiple Clinical Problems are the NORM!
Source CSAT 2009 Summary Analytic Data Set
(n20,826)
55
56
The Number of Clinical Problems is related to
Level of Care
Significantly more likely to have 5 problems
(OR5.8)
Source CSAT 2009 Summary Analytic Data Set
(n21,332)
56
57
The Number of Major Clinical Problems is highly
related to Victimization
Significantly more likely to have 5 problems
(OR13.9)
Source CSAT 2009 Summary Analytic Data Set
(n21,784)
57
58
Other Common Treatment Planning Needs Reclaiming
Futures
Source Reclaiming Futures (n 192)
59
Resources you can use now
  • Cost-Effective evidenced based practices A-CRA
    MET/CBT tracks here, more at www.chestnut.org/li/a
    pss or http//www.nrepp.samhsa.gov/
  • Most withdrawal symptoms appeared more
    appropriate for ambulatory/outpatient
    detoxification, see http//www.aafp.org/afp/2005/0
    201/p495.html
  • Trauma informed therapy and sucide prevention at
    http//www.nctsn.org/nccts and http//www.sprc.org
    /
  • Externalizing disorders medication practices
    http//systemsofcare.samhsa.gov/ResourceGuide/ebp.
    html
  • Tobacco cessation protocols for youth
    http//www.cdc.gov/tobacco/quit_smoking/cessation/
    youth_tobacco_cessation/index.htm
  • HIV prevention with more focus on sexual risk and
    interpersonal victimization at http//www.who.int/
    gender/violence/en/ or http//www.effectiveinterve
    ntions.org/en/home.aspx
  • For individual level strengths see
    http//www.chestnut.org/li/apss/CSAT/protocols/ind
    ex.html
  • For improving customer services
    http//www.niatx.net

60
References
  • Applegate, B. K., Santana, S. (2000).
    Intervening with youthful substance abusers A
    preliminary analysis of a juvenile drug court.
    The Justice System Journal, 21(3), 281-300.
  • Bhati et al. (2008) To Treat or Not To Treat
    Evidence on the Prospects of Expanding Treatment
    to Drug-Involved Offenders.  Washington, DC
    Urban Institute.
  • Capriccioso, R. (2004).  Foster care No cure for
    mental illness.  Connect for Kids.  Accessed on
    6/3/09 from http//www.connectforkids.org/node/571
  • Chandler, R.K., Fletcher, B.W., Volkow, N.D.
    (2009).  Treating drug abuse and addiction in the
    criminal justice system Improving public health
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