Hosts Kristen DeVall, Ph.D. & Christina Lanier, Ph.D. welcome Jane Pfeifer, MPA, Program Director at Center for Children and Family Futures, and Chad Rodi, Ph.D., Director at NPC Research, for discussion regarding the state of family treatment courts (FTCs). Listen as they define FTCs and how they have changed over time. They also discuss a family-centered approach, the Adoption and Safe Families Act, and more.
Hosts Kristen DeVall, Ph.D. & Christina Lanier, Ph.D. welcome Jane Pfeifer, MPA, Program Director at Center for Children and Family Futures, and Chad Rodi, Ph.D., Director at NPC Research, for discussion regarding the state of family treatment courts (FTCs). Listen as they define FTCs and how they have changed over time. They also discuss a family-centered approach, the Adoption and Safe Families Act, and more.
Dr. Kristin DeV...: Hello, and welcome back to Justice to Healing. I'm Dr. Kristen DeVall. With me today in the studio is Dr. Christina Lanier.
Dr. Christina L...: Hi, there.
Dr. Kristin DeV...: We serve as co-directors of the National Drug Court Resource Center, and we are very excited to have two guests joining us remotely today. First is Jane Pfeifer, Program Director at the National Family Drug Court Training and Technical Assistance Program at the Center for Children and Family Futures.
Jane Pfeifer: Hi, good to be with you.
Dr. Kristin DeV...: Second, we have Dr. Chad Rodi, Senior Research Associate, and Director of Research and Education and Child Wellbeing at NPC Research.
Dr. Chad Rodi: Thanks for having me.
Dr. Kristin DeV...: In today's episode, state of the field Family Treatment Courts is the latest episode in our seven part series highlighting specific types of Treatment Courts. Jane and Chad, can you talk briefly about how you became interested in Family Treatment Courts?
Jane Pfeifer: Sure. I can't even tell you the year. It was probably about 1998, maybe '97. I live in Northern California and we had had an Adult Drug Court that I was involved with in my position at the time as a probation officer. I was assigned to the unit that was serving, at that point, adults in our Adult Drug Court, providing case management.
I was really intrigued and could see at that point, having been working in the criminal justice system for a number of years, how this really was the right solution. It was frankly what probation had been doing when they were fully funded and had the right partnerships in place. At that point in my career, I could see the promise, I could see even before there were outcomes or certainly our own outcomes. It was early enough that there was just such promise.
From there, I worked at the Superior Court where we had a number of problem solving courts at the time, including the planning of a mental health court and a juvenile. Of course, at the time we're calling everything drug courts, although we came to call them other things. But we then had a Juvenile Drug Court and other case types being applied, including a family centered approach to dependency cases and other sorts of Family Court cases.
It's been how many years since then, and I've had various roles in providing training and technical assistance, and now working for the last 10 years with the Center for Children and Family Futures, focusing on Family Treatment Courts.
Dr. Kristin DeV...: That's great.
Jane Pfeifer: The Center for Children and Family Futures operates the National Training and Technical Assistance Program for Family Treatment Courts on behalf of the Office of Juvenile Justice and Delinquency Prevention.
Dr. Chad Rodi: I came to it a bit more circuitously than Jane, it sounds like. I was introduced to Treatment Courts in general and Family Treatment Courts in particular doing some local or site level evaluation. Also, I have this criss-crossing sort of a professional history where I've had the opportunity to work within welfare, substance use treatment and education and other systems level evaluations.
One of the elements that brought me to focus a lot more on Family Treatment Courts and some other program evaluation recently, has been an acknowledgement of how so many systems are interacting with the same family and [inaudible] in not necessarily collaborative way, and I agree with Jane, that one of the opportunities that I think Family Treatment Courts are doing better and better of engaging is recognizing that these families need agencies and systems to be working together, to surround them, support them. That the traditional siloed approach, child welfare in particular, but frankly, other systems. The opportunity is to bring those systems together in a collaborative fashion.
I think that's what's very compelling, and also as the research and evaluation literature has began to accumulate, I think I also would agree with Jane's assessment that there's just a lot of promise.
Dr. Kristin DeV...: It's always interesting to see how people come to this work. Thanks for sharing.
Dr. Christina L...: You started to talk a little bit about what are FTCs, how did they come to be? Maybe you can expand upon that idea. Where did Family Treatment Courts come from? Maybe provide a definite so that the listener really knows what we're talking about before we dig into some of the deeper stuff. I know in my experience, I've had some interactions with individuals within the field. When I ask about Family Treatment Courts, their definitions tend to vary as to exactly what that means. If you could talk a little bit about that.
Jane Pfeifer: Sure. It probably makes sense to start by sharing a little bit of information about why Family Treatment Courts are needed. What's the reason for them. As we talked about, the Adult Drug Courts began in 1989, in the late '80s. It really was some of the time, some visionary dependency court professionals who began to wonder if that collaborative model could help improve outcomes for children and families who are affected by substance use disorders, and who are also involved in the child welfare system.
The Family Treatment Court model, much like the Adult Drug Court model is a cross system collaborative solution, really, to better serve families who are both affected by substance use disorders, as they really, traditionally have a lower likelihood. Those families who are involved in the child welfare system, with a substance use disorder, they have a lower likelihood of successful reunification and their children tend to stay in foster care longer than children of parents without a substance use disorder.
There was a recognition that there was some additional work to be done. Could this, at the time, innovative model, this innovative work, could it be applied in a Family Court setting and have some of the same positive outcomes? The majority of families, the research says 60% to 80%, probably involved in the child welfare system are affected by substance use disorders, and most children in child welfare and placed in out of home care, have a parent with a substance use disorder.
Parents with substance use disorders are often getting their parental rights terminated and permanently terminated at higher rates when substance use is a factor. Child welfare, dependency court and treatment systems really realized they needed to collaborate, again, coming back to what Chad and I both have been saying, really needed to collaborate in a more intentional way to improve outcomes for children, parents, and family members that really no one system was able or is able to address the needs and really the complexity of cases alone.
Decades of research on the Family Treatment Court model now has shown that families involved in Family Treatment Courts experience better outcomes. Things like higher substance use disorder, treatment completion rates, shorter time in foster care, higher family reunification rates, lower termination of parental rights, fewer new child welfare petitions after reunification, lower criminal justice recidivism and cost savings per family.
Chad knows best, some of these findings have been made by NPC Research and other evaluations out there. It came from very real and very pressing need in child welfare and dependency courts that brought individuals to professionals, to the place where they thought, how can it not be worth a chance to make some difference, especially since it seemed so promising in the criminal courts.
Dr. Chad Rodi: I'd just like to expand a little bit, and Jane mentioned that there are lower rates of criminal involvement at the same time, and also shows, as we look across disciplines and across systems at the outcomes for families, when families are engaged in a substance use treatment, then there are these compounding benefits in so far as the lower criminal recidivism, even if they're not in a Family Treatment Court, although, obviously FTCs are great vehicle for many families to get engaged and get into recovery.
But also understanding that these broader implications and from a measurement and evaluation standpoint, it's a real challenge to connect these cases in the criminal justice system, in the FTC and in substance use treatment and child services. But as we're able to fill in the connections about how the use of a Family Treatment Court model can get families to a better place across those domains, you see the compounding benefit of the inner relationship between how families can find the support and services that they need.
It takes the team in an FTC, oftentimes, to bring those services and offer the accountability to keep families engaged. Like Jane said, treatment completion and length of stay in treatment, all are generally shown to be positively impacted by participating in FTC, compared to more conventional approaches from the child welfare perspective and from the criminal justice perspective.
Jane Pfeifer: Let's go back to your original question and talk a little bit about the definition, because it does help. Depending on who the listeners are, what really is a Family Treatment Court? I'll say, I guess in a nutshell, a Family Treatment Court is a coordinated, multidisciplinary, multisystemic response to address the comprehensive needs of children, parents, family members, and families, as a unit, in the child welfare system that are affected by parental substance use disorders. That's kind of a mouthful.
FTCs, I would say, are a comprehensive family-centered approach focusing on the needs of the entire family. Brings together judges, court personnel, attorneys, child welfare, substance use disorder, and mental health treatment professionals and other community partners, including those that provide developmental services for children, to collaborate and coordinate, and those are two different things, but very important pieces of this, to collaborate and coordinate services with the goal of ensuring that children have safe, nurturing permanent homes, family members receive the needed supports and services and parents achieve stable recovery within the mandatory timeframes. Those mandatory timeframes refer to the Adoption and Safe Families Act. The Adoption and Safe Families Act has a specific timeline that requires that a final decision is made in the case that the child is reunified or the case moves to termination of parental rights.
These collaborative partnerships, which is what a Family Treatment Court is between the courts, child welfare and treatment professionals, and all of those are really necessary to serve and improve outcomes for families. Another important point, as we think about Family Treatment Courts over the years is to talk for another moment about the history. We talked about where they started and the first two. One in Reno, Nevada, and one in Pensacola, Florida.
I'd like to just maybe spend a couple of minutes talking about a few of the milestones along the way. There were six common ingredients identified for Family Treatment Courts in 2002. There was federal funding that became available, and the National Association of Drug Court Professionals led the planning initiative, planning, training initiative, and trained hundreds of treatment professionals across the country for a number of years, that was really instrumental.
Those of us who work in the field, work with some of those earlier courts in a way that it's very clear how comprehensive that early training was and how that really led to a really firm foundation, strong foundation of Family Treatment Courts in the early years.
There are several other are points. I know there were practice improvements. I don't know, probably 2007 or so, there were real practice improvements at that point around children services and trauma services, specifically, and a focus on evidence-based and evidence-informed practices to serve children, parents and families. In 2013, we published the Family Treatment Court Guidelines. They were updated again in 2015 and it was specifically called guidelines because there really wasn't enough research at the time to firmly call it standards in any way, but it provided guidance to the field about how to implement, improve, and sustain a Family Treatment Court.
Then there were some large systems change initiatives around that same time, 2014 or so, about really wanting to understand what it takes to expand Family Treatment Courts, to really match the need and to integrate Family Treatment Court practices into the larger system. There were statewide system improvement program that was funded by the Office of Juvenile Justice and Delinquency Prevention, that allowed several states to really look at not only increasing the number of Family Treatment Courts, in increasing the number of families being served by their Family Treatment Courts, but also a separate part or a related part of it to have states look at the practices of Family Treatment Courts and infuse those practices outside a Family Treatment Court model. How can we work with the systems, with those practices that we know are so successful and helpful in Family Treatment Courts?
KIn 2014, there was a national strategic plan that brought together federal stakeholders and practitioners in the field. There were three goals identified at the time. Expansion of Family Treatment Courts, as I mentioned, infusion of those practices within the systems that they served and then strengthening the evidence. From there, in 2019, Family Treatment Court best practice standards, the Center for Children and Family Futures partnered with the National Association of Drug Court Professionals.
At that time, there really was enough research to be able to say that there are some standards of practice. That publication, again, 2019 was a way for there to be more specifics, honestly, some more specifics about the type of practices that are key to successful Treatment Courts and specifically Family Treatment Courts.
Dr. Kristin DeV...: I think some of what you just highlighted there, for our listeners that may be familiar with the Adult Drug Court model and say, obviously, it's this collaborative spirit, which is similar to the Adult Drug Court model. But obviously those services for children and for families and adults, really one of the hallmark features of this FTC model and how these programs are different from an Adult Drug Court that folks may be familiar with. Can you talk a little bit about how the model may have changed over time? We know the first FTC started in '94, have you seen changes in the model, or, I guess what has come since that first implementation of the program?
Jane Pfeifer: Let me talk for a moment about some of the foundational pieces of it, and then about how the model has changed over time. If I can offer a tangent here about the difference between Family Treatment Courts and other Treatment Court models, we would say that every court is a Family Court. In the sense that whether you're in a mental health court, if you're in an Adult Drug Court, if you're in a Juvenile Drug Court, and again, I'm using the term drug court and Treatment Court interchangeably. We would say that all of those participants live in families, come from families, are involved in a family unit in some way.
It behooves all of us because it strengthens recovery, ultimately, it behooves all of us to be thinking, and applying a family-centered approach. To your question about the model and how it's changed. The foundation of the Family Treatment Court model really is about, it has a collaborative solution that includes judicial oversight, comprehensive services. We talked a little bit about them already. There are Treatment Court hearings and they're frequent, weekly, or every other week.
There's therapeutic jurisprudence, which means applying the law in a therapeutic manner. Access to quality treatment and enhanced recovery support, enhanced family-based services. Often, when some folks hear the term family-centered approach, or family-based services, they immediately think of residential substance use disorder treatment, where a parent, typically a mother, could bring their child. That certainly is part of a family-centered approach, but it's just one piece in a much, much larger family-centered approach model, if you will, or a set of practices that really permeate all of the work that's done.
It's also, as Chad mentioned earlier, family and system accountability. It's holding parents accountable for the purposes of helping them complete and continue their engagement with services and support. But it's also accountability for the system, because we know that sometimes there's a breakdown in the way that services and referrals are followed up or not followed up on at some times. Timely therapeutic responses to behavior because that, at the end of the day, is the ultimate goal. It's for behavior change and long lasting change that leads to safe, and stable homes for children. Then collaborative case planning.
Those things haven't changed, although some of them, over time, have come to have a more prominent place in the model. There were seven principles that were developed over time since the first Family Treatment Courts. System of identifying families. Doing so universally and early in the case, timely access to assessment, and again, quality treatment services, enhancing recovery support using peers and collaborative case management. The use of peers and recovery supports in that way has really taken on a much more prominent role in the past decade or so. It's always been important, but now we know that it leads to better outcomes and can be demonstrated so.
It's important for peers to be part of the service array. Improved family-centered services, and particularly with a focus on healing parent-child relationships. There's a lot of other kinds of things that are part and parcel of the work of Family Treatment Courts. When we think particularly about the changes since 1994, '95, that it came from the Adult Drug Court model. It was initially focused, if not solely, primarily on the substance use disorder and on the adult client, the parent, on their progress in recovery.
That's important. No question about it, that's a big part of what makes a Treatment Court, a Treatment Court. But particularly in a Family Treatment Court, it's not enough. Over time, there's been more of a recognition that the service model itself go beyond the parent only. It moved from that to including the parent and the child, but somewhat separately in terms of case planning. I would say, now, we're really at a place where it's focused on parents, children, family members, more holistically.
Family Treatment Courts really ensure that the parent, the children, the family's progress and the Family Treatment Court is connected with the progress and the dependency case. That too is something that has changed somewhat or had a greater focus over time. I would also say, this is, unfortunately in some ways become a more recent attention to this, but the movement to make sure that Treatment Courts and particularly Family Treatment Courts are serving all families with equity, and that there's a... The field has been looking at not only on what we call the five Rs and an E. Not only looking at those five Rs, which is recovery outcomes, reunification outcomes, looking at children remaining at home when it's safe to do so. Outcomes around reentry to out of home care, and then repeat maltreatment, making sure that we're looking to reduce those and paying attention to the data.
But going beyond that and aggregating the data in a way that allows teams to look at who are the systems succeeding in serving better than other families? One of the things that we've found, and the field has really determined to be a priority and rightfully so, is that it's not enough to know whether a Family Treatment Court is successful in producing good outcomes. Of course, that's important, but we also have to ask the question, who is succeeding?
If Family Treatment Courts are successful, successful for whom? What that means is, are we disaggregating the data to be able to tell how the systems are succeeding, or not, in serving the families that are coming into the system, and that are coming into the Family Treatment Court. Really looking at equitable access and equitable outcomes, and as I mentioned, disaggregating the data, or really looking at the characteristics of those who come into the court.
Dr. Christina L...: Just, Jane, I think you might agree with this, but I don't know, but I think the main issue of Family Treatment Court, as compared with other models or other Treatment Court models is the additional complexity of having family at the center, which means that you have the child welfare, you have the child outcomes, you have family outcomes.
Whereas, typically, where we've looked at outcomes for other Treatment Courts has been pretty much focused on the adult that brought the case into the system, even while at the same time, I agree with you 100% that all Treatment Courts should be attending to the issue, but they're not central. I think that both a sign, I think, of great potential, but it also makes implementation, and because I'm a data guy, the evaluation, these programs particularly complex and requires a collaboration on multiples of what it takes, while I might be exaggerating, but may take considerably more effort to implement from the team perspective. Because you've got a whole nother set of folks that you need to be part of the team and collaborating. I think that's an important distinction.
Jane Pfeifer: Yeah, Chad, that's a great point. It often takes more partners, because you are looking at partners that are serving children, that are serving parents, that are serving families as a unit and potentially other family members. I think you might have used the phrase that families are the center and that's right. That does mean better collaboration, more collaboration and often greater need for coordination, and that is a difference, certainly.
I wanted to add one difference that is more recent and that is a focus or an emphasis on looking at serving families earlier in the process or earlier in their case or their potential case with Child Welfare. We would call that family preservation models or pre-filing models. That is, serving families with this Family Treatment Court model, this collaborative approach before a petition is filed.
There are many models... Maybe model is not the right word, there are many ways in which this is being done across the country. There's several states that have begun doing this work, but what that means is that it's an effort to keep kids home, to provide services and supports before the abuse and neglect gets to a point where a child has to be removed.
Those families, while they're still at high risk of being removed, they haven't been removed yet, a petition hasn't been filed and it really allows more of a prevention approach, which I think we'd all agree is key. That's one of the changes that we see happening. It's not a change to the model itself, it's just an expansion, I guess I would say. It's an expansion of the way that the Family Treatment Court model is being used.
Dr. Christina L...: Yeah.
Dr. Chad Rodi: Short tangent that might be too much in the weeds for this conversation. But one of the ways in which it appears that FTCs might serve, as Jane just said, in the terms of pre-filing or just an earlier intervention, is that many systems, child welfare systems have gone through a period of providing alternative response. Unfortunately, in some systems, it looks like alternative response is a delay in providing the level of intensity of services that families might have need, and have access to.
Whereas, Family Treatment Courts, when coordinated with a child welfare system that is otherwise trying to use an alternative response, can still connect people with the appropriate intensity and modality of treatment and other services. In so doing, prevents some of the delays of access or entry into recovery services, if the system is otherwise really focused on alternative response.
Dr. Christina L...: That really brings us to a good segue into the next area that we're interested in. Talking about when it comes to the child welfare system, there may be listeners who aren't really familiar with that and how that functions and operates. Can you guys talk a little bit about what's unique about the FTC model, as compared to how a child welfare case would go through the traditional, I suppose, we can call it system. What makes it unique and maybe talk about some features of the child welfare system without the FTC.
Jane Pfeifer: Sure. There's a lot to be said here. There are lots of strong practices and effective practices happening in business as usual in child welfare. There are however, challenges. I said at the beginning and it bears repeating that no one agency or organization can do this alone. It takes child welfare working with partners. I would say not just working with them, but really applying this enhanced, collaborative approach in order to do it well and to do it right, and to be able to meet the complex needs of families and to build on the strengths of these families.
The strong emphasis on substance use disorder treatment is one of the differences. The focus on early identification and really timely, quick access to substance use trauma, other mental health types of assessments, and then the appropriate level of care and quality treatment, it's not that, that's different per se, although some of those pieces are different than business as usual in child welfare. There is often a greater attention that can be paid to it because of this team approach. That this team approach that is the foundation of Treatment Courts, not just Family Treatment Courts, but Treatment Courts, this team approach is what allows for this enhanced and intensive kind of response and support for families.
It's this recovery support, case management, active engagement efforts by the entire team, not just a child welfare worker, but by the entire team. What we call warm handoffs, but really connecting parents when a referral is made, making a more comprehensive connection between the parent and the service delivery site. It's daily support, which frankly child welfare often is not able to do in regular cases.
It's more robust connection to recovery community. I'll say in a less quantitative way, it's an expanded message of hope from a wider variety of professionals. That can make a difference and does make a difference. Those team roles allows for an approach that again, that child welfare just isn't able to do by themselves. I would say that it's not just a team environment because the dependency courts have always been working with providers, of course, in the community.
But the Treatment Court team is trained and cross-trained, and well-versed in substance use disorder and co-occurring issues. They're educated in relapse and lapse and the elements of recovery. They work to disrupt stigma within the system, and with the parent. We've talked about the family-centered approach. There's an attention to the specific needs of families in a way, and in a comprehensive way that doesn't usually happen outside the Family Treatment Court setting. Chad, what would you add to that?
Dr. Chad Rodi: Nothing, really. What I think is really different from traditional child welfare case processing is characteristic of Treatment Courts in general, of course, which is the need for folks be super trusting. Child welfare in particular can be challenged in that regard, just as much as a criminal prosecutor might be in so far as needing to be focused and confident in the program's approach to securing the safety of children.
Again, it's not that dissimilar from adult Treatment Courts in that regard, but it is very different from child welfare, which is oftentimes, even if unfairly characterized as adversarial with the families they seek to serve and also their need to make sure that, just to be blunt about it, that there's not going to be... Because these programs are sometimes seen as softer or there's higher risk, which is the data does not bear out that, there are assumptions based on it.
I think that traditional case processing assumes that you're not going to trust other partners in the system, and these require people to rethink that kind of orientation towards the cross systems collaboration that both Jane and I have been speaking of.
Jane Pfeifer: One of the concrete differences, or maybe a logistics difference is the frequency of review hearings before the court. Typically, in a Treatment Court, there are a couple of different models within the model. There's what we call the integrated model, and then the parallel model. I don't know that we have time to go into the differences there, but it has to do with whether one judge is hearing both the dependency case and the progress review hearings for the Treatment Court.
Regardless though, in a Family Treatment Court setting, there are going to be frequent, as I mentioned earlier, a week or every two weeks, a review hearing versus maybe once every six months in a regular dependency case. Why that's important is if there are challenges with a parent, it could be something to do with the parents' inability or unwillingness to move forward with following through on a referral, or it could be something on the system side where there's a breakdown in the availability of the service. There are a number of different ways something can fall apart, even after the referral's made.
You certainly would rather hear that something isn't happening a week or two, as opposed to hearing about it six months after the fact. Having regular... The good news is, they're relatively short, but they're meaningful connections and allows interaction with the judge and the team in a way that keeps families, keeps parents engaged and helps to identify additional kinds of challenges or needs that any of the family members have, so that they can be connected to services. It's an attention to these kinds of details that allow the kind of progress that needs to be made for a child to be returned home or for the case to be closed.
Dr. Kristin DeV...: I think what you've really highlighted throughout both of your input has really... The complexity of the Family Treatment Court system, this program, the Family Treatment Court system is one element within this larger child welfare. Thinking about coordinating all of that in a way that allows families to be successful. I guess, for the practitioners that may be listening to this episode, if they wanted to take a more family-centered approach and really embody this in the work that they do, do you have suggestions for when they're working in case management sessions with participants or during staffing, or during the court review sessions themselves, how can they really embody this idea of a more family-centered approach?
Jane Pfeifer: That's a really, really important question, and there are a lot of things. The good news is there are a lot of things and many things that don't take extra money, and in many cases, don't even take extra time or much extra time. We don't have enough time to talk about all of them. I do have some suggestions and some strategies that can be applied in the here and now.
We also operate the National Center on Substance Abuse and Child Welfare, on behalf of the Substance Abuse and Mental Health Services Administration SAMHSA, and the Children's Bureau. We just published three modules about applying a family-centered approach, and I'd be happy to get the links so that folks can access that in more detail and understand about it in more detail.
But in the short term, I'd say, one of the things that can be done is to look at the process currently and identify ways that parents substance misuse can be identified earlier. When is it coming to the attention of the professionals that the parent has a substance use disorder or potentially has a substance use problem? The earlier it's identified, the earlier that parents can be involved in treatment and other supports.
Also, we talked about this earlier, but the active use of engagement efforts, including and specific to peer support. Our recovery support specialists or peer mentors or parent mentors, are they part of that case management and service array? If they aren't, there are many, many Family Treatment Courts out there that use this model and find it to be absolutely, not only helpful in a good idea. I think we all agree, it's a good idea to include someone with lived experience to help support a parent through this process, but there's more and more research all the time demonstrating that it results in better outcomes.
Then this seems simple, but often it's not happening or not happening as much as it could be, but moving beyond what the needs of the parent, and often there are many, but moving beyond the needs of the parent to the needs of children and other family members. When I have these discussions, a lot of times with Treatment Courts who are looking to improve their family-centered approach, they often say, "We agree with you intellectually. We know that's the right thing to do. We don't have the of money. We don't have the time. We don't have the expertise necessarily to deliver these other extra services or what they can consider extra services."
Our answer to that is, the good news is you don't have to have any of those things. Because it's not typically the Family Treatment Court that's going to be providing those services. First, it's identifying the professionals in the community who can meet that need. Usually, not always, but usually there is another funding source that can pay for that parent or child or family member to use it. Yes, it takes more time to coordinate and collaborate, and to even identify.
There's a process called community mapping. That's a really great strategy to begin with, and I'd be happy to provide more information about that to anyone who's interested. The community mapping though, is a process where you do just that, you identify what are the needs of the parents' children and families in your program. Then, you identify all of those services and supports in the communities. In the process, you also identify gaps, and that can be a longer process to fill those gaps.
It's that. Those are some strategies. On an even simpler note, I would say, adding one question to your interaction, to your intake form, to your initial engagement and ongoing engagement, tell me about your family. Tell me about your children. Tell me about how visitation, what we call family time or parenting time, how did that go? Yes, that does take a bit more time, but it really starts to make that connection that the Treatment Court is about, not only the parents' recovery, but about the family becoming healthy and stable.
Dr. Kristin DeV...: That's great.
Dr. Chad Rodi: Jane, I completely agree with you in terms of maybe some of the most important next steps is screening and assessing, not just at the individual adult level, but also looking at family needs and so forth. Your assessment of the challenge there is backed up by some recent data that we've been collecting, where there are up to around 60% of programs who are not currently assessing beyond the adult. Also, the only thing I would add to what you were saying about the importance of it, but is also, I think, yes, you're absolutely right, at a minimum be asking about the family, but also trying to implement a validated and reliable instrument accordingly, because there's a lot of anecdotal information that without adding a lot of burden, you can ask some key questions and really get down to a better sense of what the family needs altogether, and then proceeding, as you suggest, with the community assessment and identifying gaps, and then working through those issues.
But if you don't know what a family needs, then you're inhibiting, I think, your ability to attempt to find services and supports that do meet family level, child level need. It was interesting to me, in reviewing the data about how few courts were using an assessment that had anything to do with kids. I think that that's the next step.
Jane Pfeifer: Chad, that's a great point. That brings me to think about what measures of success Family Treatment Courts should be using. For those Family Treatment Courts listening out here, graduations or advancements are really important. They're really important for the team, first and foremost, they're really important to the parent and the families, but they are not an appropriate measure of success, or they're certainly not the only measure of success.
I'd like to spend a minute to talk about what I referenced earlier about the five Rs and the E. When we think about recovery as that first R, some of you may be familiar with SAMHSA's four dimensions of recovery; health, home, purpose, and community. Recovery really looks to include all of those things. The kinds of performance measures looking at time to treatment, how long does it take a parent to get in to substance use disorder and other types of treatment? How long are they in treatment? Time in treatment, and also treatment completion rates, because those are some measures that can, if not ensure, they certainly lead to, we know, they can lead stable recovery, long term recovery.
Then follow up after case closure, show off our case closure, relapse rates, where that's available. Treatment reentry, which is not negative, but it's not a bad thing, but it's an important thing to be looking at. Then the second R is about remaining home, where children not removed from their parents' care, because there are enough often in-home services and supports to allow that to happen safely. It's not just the child being removed, but depending on the circumstances, is there an opportunity to provide the right level of treatment, supports and services to the parent in order for the child to remain safely at home?
Sometimes that's possible, and sometimes it isn't. But looking at children remaining home is another item to be looking at. Then reunification. For those children who have been removed, looking at their rate of reunification, looking at the length of time in out-of-home care. Then many Family Treatment Courts also measure the length to permanency. So, how long is... That's all types of permanency, in addition to reunification, is timely permanency happening for that child? Because that too is key.
Then repeat maltreatment. Every child could be reunified in theory. Every child could be reunified, but if we're not also looking at repeat maltreatment, that is, is that child coming back into this system, is that family coming back into this system? Is there another report that we're not looking at the whole picture because reunification is only a success measure if repeat maltreatment is reduced or eliminated.
That's true for reentry too. We talk about repeat mal treatment, but then also reentry. Are children not coming back into foster care? Are they not reentering out-of-home care? The E part of five Rs and an E is about equitable access and outcomes. I mentioned it earlier, and I'll just say again, are we looking at all this data through an equity lens? Are we disrupting disproportionality in access and disparity in outcomes, and what does that look like?
Are we, as I mentioned, disaggregating the data? Are we looking at the data to determine who the system is serving well and who it isn't. What are the characteristics of those families? That's both race and ethnicity, certainly, but it's also gender, and it may also be age. How well are Family Treatment Courts serving the needs of fathers? Some are doing extraordinarily well and others are having a hard time engaging fathers. There's a real opportunity for many Family Treatment Courts to increase their engagement with fathers.
Then looking at stability measures, addressing things like housing, employment, family functioning, parenting skills. There's a whole raft of other kinds of measures as well. Then looking at individual specific FTC goals and the needs of sustainability as part of those overall measures. What would you add, Chad?
Dr. Chad Rodi: Just a couple of things. Again, my perspective is a program evaluator. I think about the metrics by which a team might be able to assess the effectiveness or the efficiency of the program. You really took us well down road, Jane, in so far as, it's not always straightforward that success is reunification or graduation or things that most programs would look at as signs of success.
I think that that's important for many programs when the team might identify what is the desired outcome? It's a little bit parallel to the child welfare permanency plan model, where that could be reunification, it most often is. But it also could be some retention of visitation. It could be that the parent who's in treatment is not ready or does not want to retain custody, but wants to retain contact and visitation. Acknowledging that for some programs it's a completely relevant and appropriate outcome to hope for, that, that is the outcome. That the outcome is not that we're going to keep this family together.
I agree that, of course, the vast majority of time, that is the plan, that is the goal. But I think it's important that we just not assume that that's the only goal, given that family's dynamics and what else is going on. When considering an evaluation, what we try to do, or what I try to do is talk to those other outcomes that are obviously short of repeat maltreatment, or removal and those other Rs. But I think there also needs to be some acknowledgement that, just as much as you don't time or a length of stay in treatment might be a better outcome or a better indicator than treatment completion, and just as much as it should be acknowledged that for some families, reunification is maybe not realistic, that we can talk more about how that's related to time to access to care relative to this child welfare clock and things like that, or time to access for treatment relative to the timeline associated with the child welfare case.
That is, I think, also another, both important conversation with the team to have, and look at the relationship between alternative outcomes and their overall model in terms of time from allegation to time to recovery services and other supports. Also, acknowledgement, as I just said, is that I think sometimes it is an acceptable or even desirable outcome that is somewhat different from... Well, in most cases, it's going to be returning to the parent involved in the program.
Jane Pfeifer: Chad, you make a really good point that Family Treatment Courts would do well to consider and add to an agenda, to have some discussion around, is an outcome, other than reunification considered a success? If the ultimate permanency for the child and hopefully timely permanency is something other than reunification, does the team consider that a success?
My guess is that some team members will say yes and others will say no, or I'm not sure. That's okay, but that has to be a discussion. Because whether it's permanent guardianship or if it's adoption, if it's adoption by family... There are all of these other kinds of alternative permanency placements that if they're timely and often, like you mentioned, they include a continuing relationship with the parent, that may be a desired or a better option, and that is individualized as you mentioned.
Of course, that's right. Teams, certainly should be talking about those things. Because the wonderful thing about the Treatment Court model is that it brings professionals together from many different disciplines. That means different values, different vision, different mandates, and all of that is really important to talk through and to have as part of the discussion, really on the front end and an ongoing basis.
Dr. Kristin DeV...: That's great. I think for the listeners a little bit more information about the AFSA timeline might be really helpful in terms of, I think this is a place where FTCs are unique, in that there's this overarching timeline that is imposed, that teams don't have any control over when that clock starts and how that really is the framework within which the Family Treatment Court then operates. Does that make sense?
Jane Pfeifer: It does. It absolutely does. The Adoption and Safe Families Act, or ASFA applies when a child has been removed. There are plenty of Family Treatment Courts that are serving families, and I alluded to this earlier, but are serving families where the child remains home. When it's safe to do so, of course that's preferable. In that case, ASFA doesn't apply.
But many are serving families where the child's been removed, and that's, Chad, I think you called it the clock ticking, the ASFA clock ticking, and that's often an analogy because it is maybe literally ticking. A little more detail about the Adoption and Safe Families Act timeline or ASFA, child welfare cases move quickly, as we know. Each child is required to have a permanency hearing no later than 12 months after the child enters foster care, and that's to determine the permanency plan for the child.
When a child's been in foster care for 15 of the most recent 22 months, the state actually has to file a petition to terminate parental rights, unless one of three conditions apply. The conditions are a relative is caring for the child, there's a compelling reason that termination would not be in the best interest of the child or the state has not provided the family the needed services within the required deadline.
In a nutshell, that's how the ASFA timeline applies. It's important to note that, ASFA was put in place initially, because children were languishing in foster care. They would be in foster care for years and years. Rightfully so, there were those who were saying, there has to be some parameters on this, there really has to be. Because there's trauma involved that we know much more today than we did when ASFA was passed in the 1990s.
It's really critical to think, or to understand that, that removal is a traumatic event for that child. When it can be avoided it safely, it absolutely should be. The prolonged trauma of a child in foster care can be additionally detrimental. That's when we think about the ASFA timeline and the importance of it. While child welfare can recite this, many of the other partners, if they haven't previously worked in the dependency court or with child welfare, some treatment providers and others may not be familiar with it.
At first, it may seem like, well, wait a minute, substance use recovery is a lifelong process. How does that square up with this ASFA clock? The good news is, it can, and it does, and parents can safely parent and have the kind of stability in a timely manner so that reunification can happen. If we're talking about these multiple clocks ticking, we also know that the child's developmental clock is ticking.
If you think about 12 months, as we to talked about this ASFA timeline, 12 months in a two year old's life, is half their lifetime. It's really important to be thinking about the timeline, and that speaks to the need, as we talked about earlier, early identification, getting services and supports and treatment available and happening as just as soon as possible, making sure that children are connected to developmental services and supports as soon as possible, because that is the best chance for reunification, if it's going to happen, reunification to happen and to be long lasting.
Dr. Kristin DeV...: That was a wonderful explanation. I appreciate that. We're wondering if we can talk a little bit more, that's one challenge or one issue for Family Treatment Courts to consider. What other, in you all's experience have you seen that might be a challenge? I know that sometimes there's discussion around the size of Family Treatment Courts. Could they be larger? Could they enroll more people, participants? Are there other issues, or, I suppose, challenges that you all have come across when it comes to Family Treatment Courts?
Dr. Chad Rodi: I'll just start with some recent research that is yet unpublished, but is forthcoming, and we confirmed what was generally suspected, which is that Family Treatment Courts are distributed unevenly across jurisdictions that not only do they differ by model in the way that Jane was talking about, but also in size. But no matter how you cut the data right now, one of the biggest challenges is that they're insufficient in current scope and scale to address what we estimate to be the need as Jane found to have 60% to 80% of child welfare cases, having parents with a need for substance use treatment.
We're looking at a model where we've only got about 6% of the potential population being served by Family Treatment Courts. It's multifactorial in the explanation for that. Whether it's treatment availability, whether it's local politics, whether it's under appreciation for the degree to which substance use contributes to cases.
We have not teased that out as far as the causes. I guess my point is that there's a big [inaudible] between those who could be served by these programs and those that have even access at the community level for those services. Family Treatment Courts are obviously very promising, but we also need to know more, as Jane was saying, for which families are they most appropriate and how do we assign resources to support more intensive services and supports that Family Treatment Courts in part represent and families might benefit differently or better from other points?
There's about 340 Treatment Courts spread across 42 states and territories in the US. Obviously, there's not even one court in every state. Seem to be related to population or need or other demographic characteristics. We are working hard to try and uncover what's driving the availability in utilization of Family Treatment Courts. But all we know now is there's a gap, and we now have empirical data that there's a potential problem there.
Jane Pfeifer: We have a saying at the Center for Children and Family Futures pertaining specifically to Family Treatment Courts, and this issue of scale, because it is a real issue. It's encouraging to know that what we see and what we intuit or that we know is being shown in the research. But the saying is, if it's better, why isn't it bigger?
That's perhaps a catchy way to point out the fact that it started out, people intuitively knew that the Treatment Court model was a better way, and now we have research that demonstrates that it does produce better outcomes. While we may not know the exact components for what contributes to those outcomes, we know that Family Treatment Court outcomes are often better than families that go through the system without the support of Family Treatment Courts.
If it's better and we can say it is better, why isn't it bigger? Chad, you mentioned local politics. I think sometimes that's it. It's perhaps real or perceived lack of resources and a need for existing Family Treatment Courts to look at efficiencies. The very, very, very few, and it's only a couple really that are serving all the families in need, or at least offering it to all the families in need, have a lot to offer the field in terms of how they're able to do that.
There's that is a particular way that communities with Family Treatment Courts really should be examining. You have to examine that from a system's perspective, because the Family Treatment Court doesn't need, and shouldn't be serving every family who's involved in the child welfare system where the parent has a substance use disorder.
It's probably every family doesn't need that level of intensity of services. But how do you know how many families do need that? What is that measure? How are you assessing that? How are you examining that? Then, what is the process to change it, to really make sure that those who are right for, if you will, or in need of that level of care, that they're receiving it?
There's a lot of work to be done. If there's one call to action, I would say, that's at the top of the list, that is one of the greatest challenges. It almost doesn't matter the size of the jurisdiction, there's often 10 or 20 or 30 families being served at any one time, and the need is almost always much greater than that.
Dr. Chad Rodi: Yeah, Jane, I completely agree. I think that the other thing that this connects to, in terms of calls to action is thinking, and maybe this is a program by program consideration, maybe this is a set of decisions that need to be better informed by research. But there is, within the adult Treatment Court model, a pretty consistent expectation that the priority should be given to high risk, high need.
In the context of Family Treatment Courts, there is less consensus about how one would define that. To some degree, a limit in our research-based understanding of how risk and need is associated with program outcomes, however you define program outcomes. I think one thing that programs could be doing more or a better job of is specifying the population that they feel is appropriate for the type of programming that they offer and also monitoring to assess how the risk needs, however those are defined, relate to programmatic success and long-term outcomes.
Assuming that it might be a high risk, high need, the risk is often in a Family Treatment Court model associated risk of repeat maltreatment or removal or things like that, and there are some standardized instruments for that. High need is not dissimilar, although, Jane, you might have a different opinion, it's not dissimilar from adult Treatment Courts in terms of the need is defined by the adult caregiver's need for treatment and need for other supportive services to reduce the risk of repeat maltreatment for the child.
But those are also assessed using different instruments, different tools. As I said, it does not appear to be a lot of consensus around how programs should be defining those dimensions as compared with what's in an adult Treatment Court where there's a more consensus around how to define risk and need.
Jane Pfeifer: Yeah. I'd agree with that, Chad, that there is not necessarily consensus and that it can't be footprinted, if you will, or it can't be taken from the adult Treatment Court directly. We talked at the beginning of our conversation here about the needs of families and I mentioned how there's a movement for Family Treatment Courts to include a track for pre-filing cases. Those that are what's often referred to as upstream. So, a petition hasn't been filed.
It's probably important to note that, by the time a petition is filed... Most Family Treatment Courts right now are serving families where a petition has been filed with the court. That is an indication that, that is a higher risk case because a petition has been filed. That's different than the criminal process. That's one of the ways in which the process is different.
I've heard some in the field say that all child welfare cases are, by definition, high risk, because a petition has been filed. Because if it could be handled informally or if families could be served voluntarily, and you mentioned alternative response, that's already been tried. Or it was so serious or significant to begin with that it had to immediately go to the point where a petition is filed.
There's some conversations happening or some discussion about, if there's an open child welfare case, it is by definition, high risk. Then the point you made absolutely about risk of what, is it risk of not being able to comply with the child welfare case plan, which would be a little more synonymous with prognostic risk on the criminal side? That really comes back to, does every family in child welfare who has a substance use disorder, are they in need of Family Treatment Court?
We would say, probably not, probably not all of them. Some families have the... Maybe this comes back to need, certainly, but have the supports necessary to be able to comply with... Not just comply, but comply and complete their service plan or their case plan without additional supports. They don't need the intensity of Family Treatment Court. I guess that's what I would say. I don't think we're disagreeing, I think it's a continued conversation and it's a way to look at and to think about how families who need this level of support and services are provided the opportunity and supported to do so, and sometimes given... We were talking about suggestions, most Family Treatment Courts are voluntary, not all, but many Family Treatment Courts are voluntary. Parents are often approached hopefully early and asked if they want to come into Family Treatment Court.
Family Treatment Court means what? I already said, it means more frequent hearings, coming before the judge more often, seeing a case manager more often, getting all the... That means more eyes on me. Thanks, I think I'll pass. My suggestion to Treatment Courts out there is, are you reapproaching that parent weeks or a month or so after they've declined? Because they may have realized at that point that they really do need the added support. They thought they could do it on their own, and now they realize they really do need that support. Is there some standardized mechanism to reach back out, not too far along in the case, but to reach back out to allow that parent a second option to come in? Because often that can be the time when a parent might agree.
It really comes back to the importance of engagement efforts, and that we really do, as a collaborative, as Family Treatment Courts, really have to think about their engagement strategies for all the families that are being referred, and that they have a standardized referral process. It's not just somebody who thinks this family would be good for Family Treatment Court, that it's actually a standardized process that has objective eligibility criteria. Those are really key pieces to making that happen.
Dr. Chad Rodi: Absolutely, I don't think we're disagreeing at all. I would say, just to add on to what you were just saying, Jane, is that the balance of the available carrots to participating in Family Treatment Court or recovery services for that matter, the carrots for that dissipate as it otherwise proceeds. Doing a model where it's only a post-removal model, which many FTCs operate, the incentives available to them to get and keep somebody engaged are reduced, relative to a pre-filing case, where you have every incentive and every sanction available to you. That just dissipates as the timeline proceeds, as the child welfare case proceeds.
I absolutely agree that getting people in sooner and more intensively engaged is always better, regardless of what I said previously about the goal. If the goal is visitation or relative placement or whatever it is, to get to permanency, or for unification or it's to reduce removal, it's always easier at the front end than it is at the back end.
Jane Pfeifer: Another strategy that I would add is, if you're not already doing it as a Family Treatment Court team, look to your parents' attorneys. Look to your parents' attorneys who should be full partners in your Family Treatment Court and ask them why parents should be in the Family Treatment Court. Look to your data. We should always be using data to tell us what are the benefits to being in a Family Treatment Court? Be able to articulate that in a meaningful way to parents so that they can make an informed decision.
Include peer support. Ideally, those who have been through the Family Treatment Court, so that they can say, "Hey, it seemed like a bad idea to me, in the beginning too, to be honest. But the more I learned about it, the more I was exposed to it, and certainly once I got in and started participating, it's the reason or it contributes to the reason that I'm in recovery today and that my children are back with me." All of those are some strategies for being able to identify the reasons why parents should participate and hopefully enhance engagement strategies around that.
Dr. Kristin DeV...: Awesome.
Jane Pfeifer: As we're talking about all of these things, it's important for me to share what doesn't necessarily sound that exciting at first, but I promise you it's important. That is governance structure. Say it with me together. No. Governance structure is the idea that you have this collaborative... Of course, you have your Family Treatment Court team that is working day-to-day with families in various capacities, and all the ways that we've talked about here, but there's policy and practice and protocol setting that has to happen. There are barriers that have to be addressed and who is doing that?
Often, the line staff, the direct service providers and professionals that are working with families don't necessarily have the ability or the authority to change policy or to shift a practice, that, that often has to come from supervisors, middle management and that sort of thing. The idea that you not only have your Family Treatment Court team, but you also have a steering committee, and there are many names for it, but this second layer, if you will, where, when the Family Treatment Court team, operational team or core team can't resolve an issue, that they're able to kick it up to somebody, to a group that's meeting monthly, perhaps, or every other month, to be able to say, here are the challenges, here are some of the... Hopefully, if they're sharing successes too, but here are some things that we need help resolving. Those are being considered by a group of people who have the ability to resolve them or to solve them.
That's a key piece. Nobody wants some more meetings and there may be an existing consortium or committee or council, or there may already be a place where all of these partners are already coming together, in which case, no need to reinvent the wheel. The Family Treatment Court piece could be a place on that agenda, a sufficient place on the agenda where they're doing those things, and I would say, also, looking at the data from the Family Treatment Court. Then there's a third layer or level, which is the executive, again, by any name, but an executive committee, which are really the leadership from all of the partner organizations and agencies.
But they're coming to gather a couple of times a year, maybe quarterly, a couple of times a year, and they're looking at long term sustainability. They're looking at changes in the law. We know a lot of states over the years have changed their laws regarding differential or alternative response, for instance, or there may be changes in many sorts of child welfare related laws or practices or regulations. They're able to have that higher level, less frequent, but higher level approach to overseeing the Family Treatment Court.
We have examples of agendas and membership and charters, and those sorts of things to share with folks if they're interested. But it really leads to longer term, sustained, but also stronger day-to-day practice when you have a structure in place, that it's not just happening on the fly.
The last thing I'll say about that as it relates to governance structure too, I've probably said it, but you hear people talking about Family Treatment Court sometimes as a court program. I'm here to say, while the court is a partner, this should be a collaborative, joint responsibility, if you will, program. It's not a program that belongs to the court. While there is leadership, of course, we know the importance of judges and their role in Treatment Courts, that this isn't a court program that the other partners are joining. This really should be jointly owned by child welfare, by substance use treatment professionals, by child development and child welfare. All of those partners should have an equal investment in it. That not only leads to sustainability, but it really allows a much more robust, I don't know this to be true, but my guess would be that it probably leads to larger programs or the ability to see the greater need across all those systems.
There's an importance in ownership, I would say. That really happens when there's a culture of, this is our program. This is each of our programs, and collectively, this is an initiative that we all are invested in.
Dr. Chad Rodi: I don't know the extent to which this is a call to action, per se. I will say though that, there are at least a couple of different resources and other ways of enhancing and improving programs. Jane mentioned it earlier, there's a National Center on Substance Abuse and Child Welfare, which is hosted by Children and Family Futures, and they're an amazing resource for training and TA, and they also have a lot of webinars and other resources for folks to start to address some of the next steps that Jane was referring to.
Then, as a plug, also something for folks to keep an eye out for, that I am, along with my colleagues at NPC Research, I'm also looking forward to getting some hot off the press findings from actual evaluation of Family Treatment Courts with whom the study has been a benefactor of working collaboratively with CFF, that will hopefully lead to ways in which different programs can prioritize their calls to action based on our findings, relative to the relationship between best practice, implementation, outcomes and costs and so forth.
Jane Pfeifer: If we have any listeners who aren't currently working in a Family Treatment Court, maybe you're working in another type of Treatment Court, I'd be remiss if I didn't take a moment and follow up on something I said earlier about every Treatment Court or every court is a Family Treatment Court. I believe that strongly. There are some steps to take, relatively realistic and reasonable steps to take.
The first one is to ask how many of your adult participants in your program have children? Somebody's asking that already, probably. But if you're not, ask that question, or determine what that question is and how many of those children are under 18? Then what are their needs. Once you know the number, what are their needs? What are the needs of those children?
Parenting and early recovery has its own unique challenges. I think everyone would agree, along with the needs of the children and parents, they are a way, again, not for the Treatment Court to meet those needs, but to connect those children and those families to the services, and that means additional partnerships. That is the network's part of this equation, that really, what are the needs? Then once you know what the needs are, what services are available in your community to meet the needs of children, parents, and family members? What partnerships do you need to either enhance or strengthen or create those relationships with those partners who are delivering, and able to provide those services?
While the first step in just determining how many children are there in the caseload, how many children are there in the participants that you're serving can go a long way to getting closer to being able to be more family-centered.
Dr. Kristin DeV...: That's great. Jane, as you were talking about the governance structure, I was thinking of the upcoming grant cycle that some of our listeners may be responding to in either implementing a new program or looking for ways in which to expand and enhance. One section of any grant proposal is talking about sustainability, and I think that's one place where people might be less clear about, what are some strategies for sustaining this program over time?
I think you've identified some really important pieces, in terms of networking, but also ways in which people can share resources and potentially strengthen those partnerships that we know what it takes to implement and sustain a successful Family Treatment Court program over time. That information was really great.
Dr. Christina L...: This has really been a wonderful conversation about Family Treatment Courts. I myself have learned many things about courts and how they operate. We want to thank our guests today, Chad Rodi and Jane Pfeifer for being here. Thank you both.
Dr. Chad Rodi: Thank you.
Jane Pfeifer: It's been my pleasure. Thank you.
Dr. Christina L...: To our listeners, we want to thank you as well for being here. Jane and Chad have provided us with a plethora of information regarding Family Treatment Courts, and we hope that you can identify ways in which you can take this information and translate it into practice. Whether you have an FTC or are looking to implement one. Continue the conversation on the Justice to Healing discussion board at ndcrc.org. Remember, we can all do better.
Speaker 5: To our listeners, we thank you for listening and we hope you enjoyed the show. Be sure to hit, Subscribe, to stay updated on the podcast. Follow us on Facebook, Twitter, and LinkedIn, to stay engaged with us and check out our website, ndcrc.org. Thanks again. Catch you next time on Justice to Healing.
The Justice to Healing Podcast is presented by the National Drug Court Resource Center and was supported by the grant number 2019 DCBXK002, awarded by the Bureau of Justice Assistance, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime in the SMART Office. Points of view or opinions in this podcast, are those of the author and do not necessarily represent the official position or policies of the United States Department of justice.