MAP Public Service Clinic Project

Photo Credit: Sylvia Blaauw, 2013

Presented 5/26/2016

Researched and written by:

Mekal Banyasz

Shireen Tabrizi

Marcel Baugh

In association with

The University of Washington’s

Daniel J. Evans School of Public Policy

& Governance

1 Banyasz, Tabrizi, Baugh

TABLE OF CONTENTS

Executive Summary ........................................................................................................................................... 3

Acknowledgements ............................................................................................................................................ 4

Chapter 1 Introduction ..................................................................................................................................... 5

1.1 Project Intent ........................................................................................................................................... 5

Snohomish County and the City of Everett .......................................................................................... 6

1.2 Research Methodology ........................................................................................................................... 6

Research Approach ................................................................................................................................... 6

Research Questions ................................................................................................................................... 6

Research Design ........................................................................................................................................ 7

Chapter 2 MAP at a Glance ............................................................................................................................. 8

Mental Health Alternatives Program .......................................................................................................... 8

Overview ..................................................................................................................................................... 8

Organizational Chart ................................................................................................................................. 8

Theory of Change ...................................................................................................................................... 9

Protocol and Standards ........................................................................................................................... 10

Data Collection ........................................................................................................................................ 11

Participation in MAP .............................................................................................................................. 12

Chapter 3 Literature Review ........................................................................................................................... 13

3.1 Therapeutic Court Models in the Literature ...................................................................................... 14

History of Therapeutic Courts............................................................................................................... 14

Functions of Mental Health and Drug Courts .................................................................................... 20

Evaluation of Therapeutic Courts ......................................................................................................... 22

3.2 Best Practices in Therapeutic Treatment ........................................................................................... 23

Behavioral Health Science & Rehabilitation ........................................................................................ 23

Evidence-Based Practices in Correctional Treatment ........................................................................ 24

Therapeutic Jurisprudence and Program Responsivity ...................................................................... 27

Chapter 4 Comparative Program Models & Evaluative Methods ............................................................ 29

4.1 Comparative Programs ......................................................................................................................... 29

Snohomish County District Court Mental Health Court .................................................................. 29

Seattle Municipal Mental Health Court ................................................................................................ 30


4.2 Suggested Evaluation Model for MAP .............................................................................................. 33

Chapter 5 Interim Evaluation of MAP ......................................................................................................... 34

5.1 Advancing Correctional Excellence Risk Need Responsivity Tool ............................................... 34

RNR Tool Use and Design .................................................................................................................... 34

5.2 Current Conditions of MAP ................................................................................................................ 35

Demographics & Intervention Category .............................................................................................. 35

Structure of Responsivity ....................................................................................................................... 35

Use of Sanctions and Rewards .............................................................................................................. 36

Data Collection ........................................................................................................................................ 36

Staffing Meetings ..................................................................................................................................... 37

Referral Process ....................................................................................................................................... 37

5.3 MAP’s RNR Results ............................................................................................................................. 38

Risk/Need ................................................................................................................................................ 38

Responsivity ............................................................................................................................................. 38

Dosage and Implementation .................................................................................................................. 38

Restrictiveness .......................................................................................................................................... 39

Chapter 6 Recommendations ......................................................................................................................... 40

Conclusion ........................................................................................................................................................ 43

Appendices ........................................................................................................................................................ 44

Appendix A MAP Organizational Chart .................................................................................................. 44

Appendix B MAP Theory of Change ....................................................................................................... 45

Appendix C MAP Eligibility Criteria ........................................................................................................ 46

Appendix D MAP Phase Requirements ................................................................................................... 47

Appendix E RNR Program Evaluation Tool Results ............................................................................ 48

Appendix E RNR Program Evaluation Tool Results Continued .................................................... 49

Appendix F Examples of Sanctions and Rewards .................................................................................. 50

Appendix G Participant Handbook .......................................................................................................... 51


Executive Summary

The Everett Municipal Court’s Mental Health Alternatives Program (MAP) is a therapeutic court

located north of Seattle. Therapeutic courts, including drug and mental health courts, are a

burgeoning innovation in the United States’ criminal justice system. As policymakers, criminal justice

reform advocates, formerly incarcerated individuals, and the public look toward alternatives to

incarceration, there is growing pressure for therapeutic courts to follow evidence-based practices

and conduct routine performance evaluations. For this reason, the MAP team solicited the help of

three students from the University of Washington Evans School of Public Policy and Governance to

answer the following research questions:

How does MAP target and screen individuals with mental health complications who interact with the Everett

Municipal Court system?

What metrics does MAP staff need to collect data around to evaluate the effectiveness of their program?

Goals

Our primary aim in answering these questions was to identify MAP’s usage of evidence-based

practices, outline the program’s process, interview staff and participants to understand the

functionalities of the program, and prepare the court for a future program evaluation.

Research Methods

To achieve these goals, we initially conducted a review of the literature around therapeutic courts,

ranging from their history to best practices with which they are associated. We also consulted and

provided examples of two evaluations conducted of local therapeutic courts similar to MAP as

frameworks for the team to consider pursuing at a later date for their own evaluation.

To provide an interim evaluation of the program, we utilized the George Mason University Center

for Advancing Correctional Excellence Risk-Need-Responsivity tool. The tool illuminated several

areas of both success and potential improvements.

Finally, we conducted several interviews with both MAP participants and staff to paint a fuller

picture of the program’s processes and outcomes. We also evaluated data received from the MAP

team regarding participant status post-treatment and participant demographics.

Recommendations

The three-year program has undergone several changes during its existence. Based on both these

changing variables and the results from the interim evaluation we conducted, we provide six

recommendations for MAP to improve its processes and outcomes:

Develop a data collection tool; Amend the referral process; Include the judge and treatment providers

at Staffing;

Redefine MAP team members’ job roles; Create a list of rewards and sanctions; and Adhere to either mental or drug court

standards.


Acknowledgements

We would like to express our gratitude to the entire Mental Health Alternatives Program staff for

their time, expertise, and welcoming disposition throughout our extensive research, observations,

interviews, and inquiry. Without their participation in this project, we would not have had the

opportunity to engage with such talented and dedicated members of our community.

We would also like to show our appreciation for the assistance we received from the Snohomish

County Drug Courts Program Manager, Janelle Sgrignioli. Her knowledge and generosity was key to

understanding the structures necessary for complex data collection and for highlighting resources

relevant to our project. The context Janelle provided as a fellow therapeutic court program

administrator was pivotal to our understanding of the climate under which therapeutic courts

operate.

City of Everett

Municipal Court

City of Everett

Prosecutor’s Office

Bridgeways, Mental

Health Services

Everett Law Group, PLLC

Judge Laura Van

Slyck

Hil Kaman

Cathy Wheatcroft

Megan Campbell

Katie Trankenschuh Flora Diaz Nicol Freeman

Snohomish County District Court

Janelle Sgrignioli

Finally, we would like to thank our advisor, Professor Greg Traxler, at the Daniel J. Evans School of

Public Policy and Governance for his support and guidance throughout the duration of the project.


Chapter 1 Introduction

1.1 Project Intent

The City of Everett, located along the northwest coast in Washington State, holds one of the several

thousand therapeutic or specialized courts established in the United States. Everett’s municipal court

program, the Mental Health Alternatives Program (MAP), is a therapeutic court situated

organizationally between drug court models and mental health court models. The Revised Code of

Washington (RCW) defines the term “therapeutic court” as:

A court utilizing a program or programs structured to achieve both a reduction in recidivism

and an increase in the likelihood of rehabilitation, or to reduce child abuse and neglect, out-

of-home placements of children, termination of parental rights, and substance abuse and

mental health symptoms among parents or guardians and their children through continuous

and intense judicially supervised treatment and the appropriate use of services, sanctions,

and incentives.1

On July 24, 2015, the Washington State Legislature formally authorized therapeutic courts under

RCW Chapter 2.30.2 This RCW chapter outlines specific structures and guidelines to which all

therapeutic courts in Washington must adhere, including the following:

…the effectiveness and credibility of any therapeutic court will be enhanced when the court

implements evidence-based practices, research based practices, emerging best practices, or

promising practices that have been identified and accepted at the state and national levels.3

In accordance with these guidelines, the purpose of this project is to identify MAP’s usage of

evidence-based practices, outline the program’s process, interview staff and participants to

understand the functionalities of the program, and prepare the court for a future program

evaluation.

Our goals are as follows:

● Understand the process and outcomes produced by MAP;

● Complete a formative evaluation of MAP;

● Make recommendations that will assist MAP with conducting a future summative evaluation

and;

● Identify the tools necessary to bolster MAP;

● Document specific methods and practices in place that may reduce recidivism amongst program

participants.

1 “Chapter 2.30 RCW: Therapeutic Courts.” Washington State Legislature. http://app.leg.wa.gov/RCW/default.aspx?cite=2.30&full=true. 2 Ibid. 3 Ibid.


Snohomish County and the City of Everett

MAP is located in Snohomish County, positioned just north of King County. The county was

named after the Snohomish people, an indigenous tribe located on the Tulalip Reservation.4

Snohomish County maintains world-class recreational opportunities as it is home to the Mount

Baker-Snoqualmie National Forest. It also has a thriving agricultural industry and is home to The

Port of Everett.

Incorporated in 1893, the City of Everett is located along the Puget Sound and is the county seat of

Snohomish County. Everett’s 2015 estimated population was 106,736.5 Located 25 miles north of

Seattle, Everett is a city with burgeoning growth and opportunity. Everett houses cutting-edge

technology, medical, and aerospace employers like Boeing, Providence Everett Medical, and The

Naval Station.6 The community has access to waterfront amenities, an arboretum, forty parks, a

wetland sanctuary, a children’s museum, historic theaters and hotels, and a growing public transit

system.

1.2 Research Methodology

Research Approach

Our work with the MAP team began by identifying metrics to evaluate the success of the program

goals set forth both internally, through stated protocol, and externally, including those required by

RCW 2.30. We compiled and analyzed existing quantitative data provided by the MAP team, and

gathered and processed qualitative data obtained through interviews with MAP participants and

staff.

We also collaborated with MAP’s neighbor, the Snohomish County Drug Court (SCDC), established

in 1997. SCDC has since developed and implemented a comprehensive data collection tool to gather

information about the program and facilitate evaluation of its outcomes. We worked with the MAP

team and SCDC professionals to develop a recommended methodology to improve future data

collection and prepare MAP to undergo a full program evaluation in the future.

Alongside these methods, we consulted pre-existing research around therapeutic courts to provide

ourselves with a context in which to situate MAP.

Research Questions

The research questions we established for this project are the following:

● How does MAP target and screen individuals with mental health complications who interact with the Everett Municipal Court system?

● What metrics does MAP staff need to collect data around to evaluate the effectiveness of their program?

4 “Snohomish Tribe of Indians History Timeline.” Snohomish Tribe of Indians. http://snohomishtribe.com/index.html. 5 “QuickFacts: Everett city, Washington.” United States Census Bureau. http://www.census.gov/quickfacts/table/PST045215/5322640. 6 City of Everett, 2016 Operating Budget: Supplemental Information. https://everettwa.gov/documentcenter/view/5548.


Research Design

Research began with a survey of the literature

regarding the history of therapeutic court

models, best practices associated with treatment

planning, risk-need-responsivity fidelity

principles, and evidence-based therapeutic court diversion

models for individuals with mental health disorders. We

also employed program evaluations of similar therapeutic

court programs for comparative analyses.

We conducted qualitative interviews with MAP’s presiding judge, prosecutors, defense attorney,

MAP Liaison, and program participants to understand the perception of the program. We assessed

MAP’s data on current and former participants to identify gaps in the data and recognizable trends

amongst participants. We also utilized the George Mason Center for Advancing Correctional

Excellence program evaluation tool to conduct a formative evaluation of MAP’s overall approach to

correctional service provision.

Future data collection is imperative to complete an evaluation of the program’s impact. Therefore,

to prepare MAP for a full evaluation in the future, we identified appropriate data collection methods

by reviewing evaluations of similar programs, including mental health courts in Snohomish County

and Seattle.

Fidelity a concept that informs

whether treatment services are delivered, consistent with program theory and design.


Chapter 2 MAP at a Glance

Mental Health Alternatives Program

Overview

The City of Everett Municipal Court established MAP in 2013 under now retired Judge David

Mitchell. Initially called the Community Justice Alternatives (CJA) program, the appointment of

Judge Laura Van Slyck, Everett’s first female judge, brought immediate changes. The new leadership

produced a fresh title, MAP, in addition to key structural changes to the program.7 The restructured

MAP team began searching for ways to improve and expand the program. Where under the

previous judge, there was no minimum time commitment required of program participants, Judge

Van Slyck implemented a minimum 12-month timeline. Judge Van Slyck also established progressive

program phases with prerequisites for advancing from one to the next, discussed in detail below in

“Participation in MAP.”

Organizational Chart

At the time of writing, the MAP team is comprised of six staff members. The team consists of a

judge, a team of prosecuting attorneys, a public defense attorney, a MAP Liaison, a court

administrator, and a judicial assistant. The MAP Liaison is a social worker employed with MAP

through a contract with Bridgeways, funded by Snohomish County through the North Sound

Behavioral Health Administration. The MAP Liaison is responsible for coordinating services like

mental health and drug treatment directly with program participants. This position, previously part-

time, became full-time in 2015.

Individual staff members’ names and titles are compiled in an organizational chart in Appendix A.

This particular team has been working together for approximately one year.

A description of each MAP staff member’s role is listed in the table on the following page. Positions

are categorized according to whether they are involved in direct client management or indirect

administration and support of the MAP team. “Direct” roles include decision-making authority,

while “Indirect” roles do not.

7 “Mental Health Alternatives Program (MAP).” City of Everett. https://www.everettwa.gov/1375/Mental-Health-

Alternatives-Program-MAP.


Direct

Judge Program oversight and management Discretionary ruling of rewards and sanctions based on MAP team

recommendations

Prosecuting Attorney Primary representative for the City of Everett in the prosecution of

misdemeanors held by MAP participants

Defense Attorney Provides legal counsel and representation for MAP participants as advocate

for the accused

Bridgeways Liaison Communicates regularly with MAP participants to provide progress updates

to MAP team during Staffing meetings Coordinates with MAP participants to ensure they are paired with services,

including housing and treatment for chemical dependency and/or mental illness

Indirect

Court Administrator Management and oversight of Everett Municipal Court’s operations,

including staffing, technology, building maintenance, etc.

Judicial Clerk Record-keeping and documentation of Staffing meeting minutes Organization of MAP calendar Compiles court documents as needed, including warrants, summons, etc.

Theory of Change

As declared by MAP, the program’s mission is to:

1. Reduce recidivism of offenders in the criminal justice system whose criminal history or

behavior is due in a significant way to mental illness or other disorder;

2. Provide community protection with a cost-effective, integrated continuum of care through

the development and utilization of community resources; and

3. Strategically focus resources within the criminal justice system.

MAP team members believe in the ability of the program to positively impact Everett and the

surrounding community by providing participants with a treatment-focused alternative to

incarceration. By addressing the underlying factors contributing to criminal activity through

treatment matching and individualized sanctions and rewards, MAP aims to reduce recidivism rates

10 Banyasz, Tabrizi,

Baugh

among program participants. As a result, communities are made safer and taxpayer dollars are saved

through reduced incarceration rates. For a visual depiction of MAP’s Theory of Change as stated

here, see Appendix B.

Protocol and Standards

MAP emerged from a political environment that was conducive to the use of therapeutic court

models, supported by multiple pieces of recent legislation. As mentioned previously in Chapter 1

Introduction, in 2013, the Washington State Legislature encouraged the creation of a work group to

analyze and recommend best practices of therapeutic courts through SB 5797. More recently, SB

5107 was passed in 2015 to revise existing RCW around therapeutic courts.

Several eligibility criteria exist for entry into MAP, listed in full in Appendix C. The majority of these

criteria exist to protect the safety of other MAP participants and program staff, including restrictions

against individuals with charges related to violence or sexual assault. However, there are exceptions

to these restrictions in cases involving individuals with mental health and/or chemical dependency

issues. In these cases, certain prerequisites to entry must be satisfied, including thorough mental

health and/or chemical dependency evaluations and establishment of a treatment plan. Individuals

in custody also can and have been referred to MAP. However, difficulties can emerge for this

population of people in entering the program, as will be discussed below in the “Participation in

MAP” section.

Following referral to MAP, potential participants must observe the MAP calendar twice before they

are eligible to join the program.


Baugh

Data Collection

Content and Structures

The importance of standardizing data collection processes cannot be understated. To understand the

processes within MAP, and provide future researchers and interested parties with usable data for

evaluation, we evaluated the current data collection methods and structures. We found that data

collection is obtained by several team members of MAP for their own usage, but that the methods

and structures are not connected and are somewhat unevenly acted upon. The following table

outlines the methods and structures used by the MAP team:

Participant Tracking

Recidivism, as defined by MAP staff is any crime charged to a program graduate post-graduation.

Judge Van Slyck completes a monthly check of participants who have graduated by reviewing their

current Washington State criminal history. This includes the number of criminal charges a

participant had before, throughout, and after program participation. MAP Liaison Cathy Wheatcroft

tracks participants as they move through the program. She collects demographic data, meets with

MAP participants and their service providers, as well as ensures that participants have access to the

necessary resources for their success.

Data Collection Content and Structures

MAP Team Content Structures

Judge Laura Van Slyck Criminal charges, phase completion, date of program entry and exit, demographics.

MS Excel Paper files Email

Prosecuting Attorney Criminal files including pending charges.

Paper files Email MS Word

Public Defense Attorney All referrals-past, present and potential.

Email Paper files

MAP Liaison Healthcare statuses, medication compliance, patterns of contact, housing statuses, treatment and goal plans.

Bridgeways internal email Paper files Excel Digital, text messages and phone calls In-person meetings

Judicial Assistant This role does not require data collection.

Court Administrator This role does not require data collection.


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Participation in MAP

Referral Process

Prior to participation in MAP, potential clients are referred through a number of sources including,

but not limited to: emergency or mental health service providers, law enforcement, jail staff, defense

attorneys, prosecutors, or family members.

According to the MAP protocol, any referral originating from a source other than the defense

attorney will be referred to the defense attorney. Given the large number of referrals, this can be

burdensome on the defense team. In addition, according to the MAP defense attorney, the majority

of referrals over the past six months have not resulted in the addition of any new participants to the

program. Many referrals were for participants who did not fit stated eligibility criteria, while others

were for individuals in custody at the time of referral.

Program Phases

As stated in the “Protocols and Standards” section, participants cannot engage in MAP without first

participating in an observation period lasting about six weeks. During the Observation Phase,

individuals must observe two different MAP calendar hearings to become eligible for the program.

Unfortunately, given its long duration, many potential MAP candidates often fall off during this

phase. It is seemingly the particularly self-driven and motivated candidates who enter into the

program from the Observation Phase.

MAP is divided into three programmatic phases, which together last a minimum of 12 months. The

first phase must last at least two months, the second at least four months, and the third at least six

months, unless the 12-month minimum has already been reached.

Program participants must achieve several stated goals before progressing onto the next phase,

shown in the diagram below. Upon completion of all three phases, both the MAP team and their

fellow program participants celebrate graduates during a graduation ceremony that occurs during a

pre-scheduled MAP calendar hearing (see Appendix D for MAP Phase Requirements).

Program Capacity

As of the first quarter of 2016 there are approximately 32 active MAP participants. The MAP team

desires growth in their participant capacity and there may be room for expansion. However, it is not

clear how MAP’s capacity is determined, therefore it is difficult to determine by how much the

program can be expanded in the future.


Baugh

Chapter 3 Literature Review

This literature review follows the historic and present-day trends of drug court models and their

progeny of therapeutic court models (sometimes referred to as specialty courts). Through this review

of literature, we outline research on:

● the functions of therapeutic courts and their role within the traditional court system;

● the establishment of therapeutic courts and the reason for their burgeoning but quiet

success, nationally and locally in Washington State;

● the development of inter-agency collaborations required to operate therapeutic courts;

● the populations most served by this method of adjudication;

● the complexities surrounding the ability to evaluate therapeutic court programs;

● advances in appropriate treatment models, and;

● the progression of treatment theories through studies of past evaluations.

All therapeutic court models stem from the drug court model, the first iteration of a therapeutic

court model. Because the drug court model was at the forefront of the therapeutic court model

movement, we isolate the differences between drug courts and mental health courts to identify the

unique position that a program like MAP inhabits.

Additionally, as each therapeutic court is a unique organism, any changes made to staff, treatments,

sanction and reward systems, etc. may alter the overall outcomes of the program and therefore

challenge the validity of an evaluation. Further research remains necessary to understand the limits

of evaluating mental health court programs.

The political environment in the United States has changed over the past few decades regarding

policies, methods, and expected outcomes in processing individuals accused of crimes. We recognize

the salience of these elements in mental health treatment practices. Furthermore, we thoughtfully

address the changing norms of the justice system and the connection between individuals with

mental health histories and criminogenic potential.


Baugh

3.1 Therapeutic Court Models in the Literature

History of Therapeutic Courts

Emergence of Therapeutic Courts

The introduction of therapeutic, or problem-solving, courts in the United States began as a response

to the growing inability of overwhelmed court systems to address substance abuse and mental health

issues,8 that was largely caused by the War on Drugs stretching resources thin. By the early 1990s,

drug-related crimes comprised nearly one third of all convictions at the state level.9

People with drug-related offenses often lacked the support services needed to address substance

abuse or mental health problems that commonly accompany substance abuse. As the Honorable

John R. Guthmann described in Ramsey County Mental Health Court: Working with Community

Partners to Improve the Lives of Mentally Ill Defendants, Reduce Recidivism, and Enhance Public

Safety10, this created a “revolving door from the streets to the courthouse, to jail, and then back to

the streets where the cycle begins anew.”11 The criminal justice system was therefore forced to look

for alternatives to incarceration, including the use of therapeutic courts. Following the realization of

this need for change, and the strong support of federal monies, therapeutic courts have proliferated

since the 1980s. Today, there are over 150 mental health courts12 and more than 2,000 drug courts13

in the United States.

The first therapeutic courts to emerge, drug courts accompanied the rise of drug-related convictions

in the United States. With the emergence of drug courts, the National Association of Drug Court

Professionals (NADCP) in association with the Bureau of Justice Assistance (BJA) developed the

Ten Key Components of drug and problem-solving courts, outlined on the following page.14

8 Guthmann, John H. "Ramsey County Mental Health Court: Working with Community Partners to Improve the Lives

of Mentally Ill Defendants, Reduce Recidivism, and Enhance Public Safety." William Mitchell Law Review 41, no. 3 (2015): 948-91. 9 Ibid. 10 Ibid. 11 Ibid., 951. 12 U.S. Department of Justice. Bureau of Justice Assistance. “Mental Health Courts Program.” Office of Justice Programs.

https://www.bja.gov/ProgramDetails.aspx?Program_ID=68#horizontalTab1. 13 U.S. Department of Justice. National Institute of Justice. “Drug Courts.” Office of Justice Programs.

http://www.nij.gov/topics/courts/drug-courts/pages/welcome.aspx. 14

The National Association of Drug Court Professionals, Defining Drug Courts: The Key Components. Washington, DC: U.S.

Department of Justice Office of Justice Programs, 2004. http://www.courts.ca.gov/documents/DefiningDC.pdf.


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The Ten Key Components

1. Drug courts integrate alcohol and other drug treatment services with justice system case processing.

2. Using a no adversarial [sic] approach, prosecution and defense counsel promote public safety while protecting participants' due process rights.

3. Eligible participants are identified early and promptly placed in the drug court program.

4. Drug courts provide access to a continuum of alcohol, drug, and other related treatment and rehabilitation services.

5. Abstinence is monitored by frequent alcohol and other drug testing.

6. A coordinated strategy governs drug court responses to participants' compliance.

7. Ongoing judicial interaction with each drug court participant is essential.

8. Monitoring and evaluation measure the achievement of program goals and gauge effectiveness.

9. Continuing interdisciplinary education promotes effective drug court planning, implementation, and operations.

10. Forging partnerships among drug courts, public agencies, and community-based organizations generates local support and enhances drug court program effectiveness.

In contrast to traditional court models, the Ten Key Components place emphasis on “‘the needs and

circumstances of the individuals involved in the dispute’” rather than merely the dispute itself.15

When compared with traditional sentencing processes, therapeutic courts effectively reduce

recidivism rates, as they typically focus on factors proven to reduce recidivism such as individualized

treatment and risk assessment, as discussed in the previous section, “Functions of Mental Health

and Drug Courts.”

Mental health courts came into existence for reasons similar to drug courts. As the prison

population grew over the past few decades, so did the proportion of prisoners with recognized

mental illness. Their needs were often unmet by prison resources.16 According to Guthmann, “sixty-

four percent of jail inmates and fifty-six percent of state prison inmates had either a history or

symptoms of a mental illness” in the year 2005.17 Even more starkly, the Treatment Advocacy

15 Guthmann, John H. "Ramsey County Mental Health Court: Working with Community Partners to Improve the Lives

of Mentally Ill Defendants, Reduce Recidivism, and Enhance Public Safety." William Mitchell Law Review 41, no. 3 (2015): 954. 16 Ibid., 948-91. 17 Ibid., 958.


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Center found in 2012 that the number of people with serious mental illness in United States prisons

and jails was ten times higher than those in state psychiatric hospitals.18

It has become clear to policymakers, criminal justice workers, service providers, and the public that

traditional court models demonstrate little evidence that they address the unique needs of the

significant population of offenders with mental health problems. Mental health courts build upon

the drug court’s central tenants previously outlined, including the Ten Key Components, adding an

emphasis on supervised community-oriented treatment and a team-based court environment.19 The

Council of State Governments Justice Center collaborated with the BJA to institutionalize and

standardize these characteristics of mental health courts. They established the Essential Elements of

mental health courts as illustrated on the following page:20

18 Treatment Advocacy Center, The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey. Arlington, VA:

Treatment Advocacy Center, 2014. http://www.tacreports.org/storage/documents/treatment-behind-bars/treatment-behind-bars.pdf. 19 Guthmann, John H. "Ramsey County Mental Health Court: Working with Community Partners to Improve the Lives

of Mentally Ill Defendants, Reduce Recidivism, and Enhance Public Safety." William Mitchell Law Review 41, no. 3 (2015): 948-91. 20 Council of States Governments Justice Center, Improving Responses to People with Mental Illnesses: The Essential Elements of a

Mental Health Court. New York, NY: Council of State Governments Justice Center, 2007. https://www.bja.gov/Publications/mhc_essential_elements.pdf.


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The Essential Elements of Mental Health Courts

Planning and Administration

A broad-based group of stakeholders representing the criminal justice, mental health, substance abuse treatment, and related systems and the community guides the planning and administration of the court.

Target Population

Eligibility criteria address public safety and consider a community’s treatment capacity, in addition to the availability of alternatives to pretrial detention for defendants with mental illnesses. Eligibility criteria also take into account the relationship between mental health illness and a defendant’s offenses, while allowing the individual circumstances of each case to be considered.

Timely Participant Identification and Linkage to

Services

Participants are identified, referred, and accepted into mental health courts, and then linked to community-based service providers as quickly as possible.

Terms of Participation

Terms of participation are clear, promote public safety, facilitate the defendant's engagement in treatment, are individualized to correspond to the level of risk that the defendant presents to the community, and provide for positive legal outcomes for those individuals who successfully complete the program.

Informed Choice

Defendants fully understand the program requirements before agreeing to participate in a mental health court. They are provided legal counsel to inform this decision and subsequent decisions about program involvement. Procedures exist in the mental health court to address, in a timely fashion, concerns about a defendant's competency whenever they arise.

Treatment Supports and Services

Mental health courts connect participants to comprehensive and individualized treatment supports and services in the community. They strive to use-and increase the availability of-treatment and services that are evidence-based.

Confidentiality

Health and legal information should be shared in a way that protects potential participants' confidentiality rights as mental health consumers and their constitutional rights as defendants. Information gathered as part of the participants' court-ordered treatment program or services should be safeguarded in the event that participants are returned to traditional court processing.

Court Team

A team of criminal justice and mental health staff and service and treatment providers receives special, ongoing training and helps mental health court participants achieve treatment and criminal justice goals by regularly reviewing and revising the court process.

Monitoring Adherence to Court

Requirements

Criminal justice and mental health staff collaboratively monitor participants' adherence to court conditions, offer individualized graduated incentives and sanctions, and modify treatment as necessary to promote public safety and participants' recovery.

Sustainability

Data are collected and analyzed to demonstrate the impact of the mental health court, its performance is assessed periodically (and procedures are modified accordingly), court processes are institutionalized, and support for the court in the community is cultivated and expanded.


Baugh

National Perspective

From the 1960s to 1990s, there was very little scientific research conducted on the different

behavioral health outcomes that individuals receiving individualized correctional treatment,

unspecific general correctional treatment, inappropriate treatment, or criminal sanctions

experienced. Many studies failed to evaluate or indicate a significant difference in the recidivism

outcomes of offenders receiving treatment versus those not receiving treatment, leading to the

propagation of the notion that “nothing works” for rehabilitation.21 The widely held notion that

nothing worked became the basis for tough on crime bills that led to mass incarceration with less

focus on correctional treatment during the 1980s and 1990s.

In 1968, Richard Nixon ran on a platform of Law and Order, stating that, “doubling the conviction

rate in this country would do more to cure crime in America than quadrupling the funds for

[Hubert] Humphrey’s War on Poverty.”22 Following this platform, President Ronald Reagan

expanded Nixon’s tough on crime legislation through federal interventionist policies backed by

significant financial appropriations. By 1985, 78 percent of federal funds were going to Law

Enforcement, with only 22 percent allocated to drug prevention and/or treatment programs.23 By

October of 1986, Reagan signed the Anti-Drug Abuse Act into law, which led to mandatory

minimum sentencing for nonviolent drug offenses.24,25 Fortunately, drug courts emerged in the late

1980s to address the ballooning population of people indicted/incarcerated for drug-related crimes.

The expansion of problem-solving courts was aided by behavioral health scientists interested in

measuring the effects that correctional treatment had on recidivism.

Washington State Perspective

The first of Washington State’s therapeutic courts began in King County, in August of 1994.26 Pierce

County quickly followed in October of the same year.27 As of 2016, there are 83 therapeutic courts

registered with the Administrative Office of the Courts in Washington, of that, there are two

municipal courts and 13 mental health courts.28

21 Andrews, Donald A., I. Zinger, R.D. Hoge, and J. Bonta. “Does Correctional Treatment Work? A Clinically Relevant

and Psychologically Informed Meta-Analysis.” Criminology, 28.3 (1990): 370. 22 Political Research Associates. “Rise of the Modern Tough on Crime Laws.” In Defending Justice. Somerville, MA:

Political Research Associates, 2005: 43. http://www.publiceye.org/defendingjustice/pdfs/chapters/toughcrime.pdf. 23 Ibid., 54. 24 U.S. Sentencing Commission, 1995 Report to the Congress: Cocaine and Federal Sentencing Policies.

http://www.ussc.gov/research/congressional-reports/1995-report-congress-cocaine-and-federal-sentencing-policy. 25 Political Research Associates. “Rise of the Modern Tough on Crime Laws.” In Defending Justice. Somerville, MA:

Political Research Associates, 2005: 43-68. 26 “King County Adult Drug Diversion Court.” King County. http://www.kingcounty.gov/courts/clerk/drug-court.aspx. 27 University of Washington Alcohol and Drug Abuse Institute, “Appendix B2. County Drug Court Profiles: Pierce

County Drug Court Program Profile.” NW HIDTA/DASA Washington State Drug Court Evaluation. Seattle, WA: Alcohol and Drug Abuse Institute, 2001. http://adai.washington.edu/pubs/drugcourt/appendb2.pdf. 28

“Drug Courts & Other Therapeutic Courts.” Washington Courts.

http://www.courts.wa.gov/court_dir/?fa=court_dir.psc.

http://heinonline.org.offcampus.lib.washington.edu/HOL/AuthorProfile?action=edit&search_name=%20Andrews,%20D.%20A.&collection=journals

http://heinonline.org.offcampus.lib.washington.edu/HOL/AuthorProfile?action=edit&search_name=Zinger,%20Ivan&collection=journals


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In 1997, King County led the way in Washington, creating a task force to formulate a mental health

court program, modeled after the nation’s first mental health court in Broward County, Florida.29

The courtroom models predominantly used in all 12 counties in Washington follow the guidelines

developed by Council of State Governments Justice Center shown in the previous chart. The full

duration of programming spans anywhere between 6 and 24 months. The key findings derived from

King County’s Mentally Ill Offender Task Force produced four recommendations:

1. Establish a Mental Health Court with a dedicated judge, prosecutor, and defender to handle cases involving mentally ill offenders;

2. The Court must offer defendants access to flexible and individualized treatment packages through community mental health providers and other agencies;

3. It shall employ the services of a Court Monitor and specialized probation officers to act as linkages between the Court and service providers, and to monitor cases to ensure compliance, and

4. Hire consultants to perform two evaluations of the Mental Health Court, a process evaluation after one year and an outcome evaluation after two to three years.30

It was presumed that through a specialized court docket, successes similar to those observed in the

drug court model could be acquired. Effectively, preventing individuals with mental health issues

accused of crimes a better shot at treatment and rehabilitation, instead of the costly alternative,

incarceration without treatment.

29 Rogers, Randy T. “Mental Health Courts Fad or Future?” Butler County Probate Court. July 6, 2005.

http://www.butlercountyprobatecourt.org/pdf/mental%20health%20courts%20-illustrated.pdf. 30 Ibid., 3.


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Functions of Mental Health and Drug Courts

Mental health and drug courts are examples of therapeutic court models that work within a legal

framework to provide individuals with opportunities beyond traditional courtroom adjudication and

connect them to services not readily available in traditional court models. Therapeutic courts’

primary functions are to reduce recidivism, rehabilitate individuals, and reduce the prison

population. This is not meant to imply that traditional courts do not maintain similar purposes.

Although, their differences lie in the practice of adjudicating cases. Therapeutic courts utilize a set of

standard sanction and reward practices, inside the courtroom and mete out justice in settings outside

of incarceration and parole. According to the BJA, the differences between drug courts and mental

health courts are as follows:31

Program Component

Drug Courts Mental Health Courts

Charges Accepted

Focus on offenders with drug related charges.

Include a wide array of charges.

Monitoring Rely on urinalysis or other types of drug testing to monitor compliance.

Attendance regarding treatment plans takes place if applicable in lieu of formalized test.

Treatment Plans

Make treatment plans structured and routinized; apply sanctioning grid in

response to non-compliance, culminating with a brief jail sentence.

Ensure that treatment plans are individualized and flexible; adjust treatment plans in response to non-adherence along with application of

sanctions; rely more on incentives; use jail less frequently.

Role of Advocates

Feature only minimal involvement from community advocacy community.

Have been promoted heavily by some mental health advocates, who are often involved in the operation of specific programs; other mental health advocates have raised concerns about

mental health courts, in general or regarding design.

Service Delivery

Often establish independent treatment programs, within the courts’ jurisdiction.

Usually contract with community agencies; require more resources to coordinate service for participants.

Participant Expectations

Require sobriety, education, employment, self-sufficiency, payment of court fees; some charge participation fees.

Recognize that even in recovery, participants are often unable to work or take classes and require ongoing case management and multiple supports; few charge a fee for participation.

31 Council of States Governments Justice Center, Mental Health Courts: A Primer for Policymakers and Practitioners. New

York, NY: Council of State Governments Justice Center, 2008. https://www.bja.gov/Publications/MHC_Primer.pdf. Note: Information altered to indicate monitoring practices of Mental Health Courts.


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In addition to mental health courts arising from drug courts, the comparison of mental health and

drug courts remains relevant due to the nature of comorbidity or prevalence of co-occurring

disorders in individuals that interact with the criminal justice system and require specialized

treatment. BJA finds that:

Among mental health court participants, co-occurring psychiatric and substance abuse

disorders are the rule, not the exception, a fact that must be considered in all aspects of the

court’s operation.32

The above finding indicates the complex realities of therapeutic court programs. They must

accurately address the needs of defendants by providing individualized treatment plans that include

physical and evidence-based mental health restoration.

In addition to the frequency of co-

occurring psychiatric and substance abuse

disorders, indigence and homelessness is often

another accompanying layer to the issues experienced

by MAP participants. Nationally, approximately 15

percent of the jail population was homeless in the year

leading up to their incarceration, a rate which is 8 to

11 percent higher than that of the general

population.33 A 2014 study found residential

instability, or lack of stable long-term housing, to be a significant predictor of successful completion

of mental health court programs.34 Homelessness is a growing issue both locally and across

Washington. In 2014 Washington was ranked 6th in the nation for homelessness.35 The City of

Everett had 44% of Snohomish County’s homeless population as counted for the 2015 Point in

Time count.36 Based on data from a sample of over four hundred mental health court participants,

individuals with residential instability were 146.6 percent more likely than their residentially stable

counterparts to fail to complete therapeutic court programs.37

32 Council of State Governments. A Guide to Mental Health Court Design and Implementation. New York, NY: Council of

State Governments, 2005: 58. https://www.bja.gov/Programs/Guide-MHC-Design.pdf. 33 Broner, Nahama, M. Lang, and S.A. Behler. “The Effect of Homelessness, Housing Type, Functioning, and

Community Reintegration Supports on Mental Health Court Completion and Recidivism.” Journal of Dual Diagnosis 5 (2009): 323-356. 34 Verhaaff, Ashley and H. Scott. “Individual Factors Predicting Mental Health Court Diversion Outcome.” Research on

Social Work Practice 25, no. 2 (2014): 213-228. 35 Ryan, John. “After 10-Year Plan, Why Does Seattle Have More Homeless Than Ever?” KUOW News and Information.

March 3, 2015. http://kuow.org/post/after-10-year-plan-why-does-seattle-have-more-homeless-ever. 36 Snohomish County Human Services, “Unsheltered Breakout.” 2015 PIT Summary for Snohomish County.

http://snohomishcountywa.gov/DocumentCenter/View/29736. 37 Ibid.


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Evaluation of Therapeutic Courts

Determining whether an organization has met its stated goals is an essential part of any

programmatic work. In the case of MAP, this is particularly true since the program is in part

supported through taxpayer-funds as it is a component of the Everett Municipal Court system.

Although, the majority of funding is received through grant funds. MAP’s stated goals of reducing

recidivism and increasing public safety must therefore be evaluated to meet the standards of

therapeutic courts as outlined by RCW Chapter 2.30 and to ensure taxpayer dollars are being spent

effectively.

Choosing which outcomes to measure, however, can become quite complicated when evaluating

therapeutic court models. According to the authors of Interventions for Drug-using Offenders with

Co-occurring Mental Illness, “focusing on only one or two outcomes may mask the impact of

treatment on other outcome domains that are of interest to various stakeholders.”38 It is therefore

crucial to think critically about the outcomes against which MAP’s success will be measured.

Components and outcomes are discussed in greater detail in Chapter 5.

38 Perry, Amanda E., M. Neilson, M. Martyn-St James, J.M. Glanville, R. McCool, S. Duffy, C. Godfrey, and C. Hewitt.

"Interventions for Drug-using Offenders with Co-occurring Mental Illness." The Cochrane Database of Systematic Reviews 1 (2014): 22.


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3.2 Best Practices in Therapeutic Treatment

Behavioral Health Science & Rehabilitation

The expansion of problem-solving courts was aided by the work of behavioral health scientists

interested in measuring the effects that correctional treatment had on offender recidivism patterns.

In, “Does Correctional Treatment Work? A Clinically Relevant and Psychologically Informed Meta-

Analysis,” university professors, clinical psychologists, and correctional service providers analyzed

the results of hundreds of randomized and nonrandomized evaluations of adult and juvenile

correctional diversion, community, and residential programs. Andrews et al.’s meta-analysis revealed

a statistically significant relationship between case, service, and participant outcomes; in that,

individualized correctional rehabilitation services led to a significant reduction in recidivism.39

Andrews et al.’s study demonstrated that despite the variation in the prior characteristics of

offenders, characteristics of correctional workers, specifics of the content and process of services

planned/delivered, and intermediate changes in the disposition and circumstances of the offender,

offenders who entered appropriate correctional programs experienced a significantly higher

treatment effect and lower rate of recidivism than those who received unspecific, inappropriate, or

criminal sanction-based treatment. Their work reinforced the notion that “the effectiveness of

correctional treatment is dependent upon what [treatment] is delivered to whom in particular

settings.”40

39 Andrews, Donald A., I. Zinger, R.D. Hoge, and J. Bonta. “Does Correctional Treatment Work? A Clinically Relevant

and Psychologically Informed Meta-Analysis.” Criminology, 28.3 (1990): 369. 40

Bonta, James and D.A. Andrews, “Risk-Need-Responsivity Model for Offenders Assessment and Rehabilitation.” Her

Majesty the Queen in Right of Canada (2007): 5.



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Evidence-Based Practices in Correctional Treatment

Risk-Need-Responsivity

Following Andrews et al.’s 1990 study, Bonta et al. produced additional evidence-based guidance

that therapeutic court administrators and treatment providers could use to develop appropriate

treatment plans. The results from well-controlled program evaluations revealed significantly lower

recidivism rates for participants who were placed in correctional treatment programs that adhered to

the following principles:

1. Risk: Service based on an assessment of the offender’s risk of reoffending. High- to moderate-

risk individuals should be prioritized for more structured and more intensive treatment and

control programs to maximize outcomes; low-risk individuals should be prioritized when they

have high criminogenic needs.

2. Need: Treatment based on an assessment of the offender’s criminogenic needs. Factors that

affect psychosocial functioning such as mental health condition, housing stability, and

educational attainment are important stabilizers and destabilizers and should be used to

determine the level of need.

3. Responsivity: Use of styles and modes matched with the learning styles of offenders (e.g.,

Cognitive Behavioral Therapy, Moral Reconation Therapy, etc.). Factors that affect

psychosocial functioning such as mental health condition, housing stability, and educational

attainment are important stabilizers and destabilizers and should be used to determine the level

of need.41,42

The Risk-Need-Responsivity principles should be engaged when designing individualized treatment

plans. It is important to note that the Responsivity principle requires treatment-matching based on

the risk factors and needs assessments.

41 Ibid., 1. 42

George Mason University Department of Criminology, Law, & Society. “Risk-Needs-Responsivity (RNR) Simulation

Tool.” Center for Advancing Correctional Excellence (ACE!). https://www.gmuace.org/research_rnr.html.


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Risk

According to Bonta et al., the Risk principle

consists of two risks, divided as static and

dynamic. Static risks are preexisting offender

characteristics that cannot be changed with treatment.

Examples of static risk factors include:

● criminal conviction history

● first mental health diagnosis

● first use of illicit substances, etc.43,44

There are many static risks to consider, however, most effective correctional programs recommend

treatment based on offenders’ dynamic risk factors also known as criminogenic needs.

Need

Dynamic risks (or criminogenic needs) can be assessed and changed with appropriate treatment

matching. Criminogenic needs are categorized under the “Central Eight” major predictors of

criminal behavior, listed on the proceeding page.45,46

43 Bonta, James and D.A. Andrews, “Risk-Need-Responsivity Model for Offenders Assessment and Rehabilitation.” Her

Majesty the Queen in Right of Canada (2007): 5. 44 Latessa, Edward J. and C. Lowenkamp. “What are Criminogenic Needs and Why are they Important?” For the Record,

4th Quarter (2005): 15. 45 Ibid. 46

Bonta, James and D.A. Andrews, “Risk-Need-Responsivity Model for Offenders Assessment and Rehabilitation.” Her

Majesty the Queen in Right of Canada (2007): 5.


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The table below lists the major risk/need factors, their indicators, and provides examples of

responsive intervention objectives:47

The Eight Major Risk/Need Factors

Major Risk/Need Factor Indicators Intervention Goals

1. Antisocial personality pattern

Impulsive, adventurous

pleasure seeking,

restlessly aggressive and

irritable

Build self-management skills, teach anger

management

2. Pro-criminal

attitudes

Rationalizations for

crime, negative attitudes

towards the law

Counter rationalizations with prosocial

attitudes; build up a prosocial identity

3. Social supports for

crime

Criminal friends,

isolation from prosocial

others

Replace procriminal friends and associates

with prosocial friends and associates

4. Substance abuse Abuse of alcohol and/or

drugs

Reduce substance abuse, enhance

alternatives to substance use

5. Family/marital

relationships

Inappropriate parental

monitoring and

disciplining, poor family

relationships

Teaching parenting skills, enhance warmth

and caring

6. School/work Poor performance, low

levels of satisfaction

Enhance work/study skills, nurture

interpersonal relationships within the context

of work and school

7. Prosocial

recreational

activities

Lack of involvement in

prosocial recreational/

leisure activities

Encourage participation in prosocial

recreational activities, teach prosocial hobbies

and sports

8. Criminal History Static risk factors cannot be changed.

47 Ibid., 6.


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Correctional treatment programs are advised to assess an offender’s criminogenic needs and risk of

recidivating before recommending intervention services. Although, knowing a client’s risks and

needs is not enough, it is important to remember that positive outcomes are related to how services

are delivered. These methods reinforce the importance of including appropriate remedies for an

individual’s socio-biological personality factors.

Responsivity

Responsive interventions prioritize treatment services that address an individual’s most immediate

needs. For instance, if an individual suffers from co-occurring disorders--e.g., mental health disorder

and substance abuse disorder--it may be best to address an individual’s mental health disorder before

delivering chemical dependency treatment. Regardless of the treatment regimen, the most effective

cognitive social learning programs ensure that services are delivered by adhering to the two core

principles of responsivity:

1. The relationship principle--establishment of a respectful/collaborative working alliance with the client.

2. The structuring principle--concerted influence on prosocial change through appropriate modeling, reinforcement, and problem-solving.48

When adhering to need and responsivity principles to facilitate behavior change, Andrews et al.

designates assessing criminogenic needs and providing appropriate treatment as appropriate courses

of action.49

Therapeutic Jurisprudence and

Program Responsivity

There have been expansions to public and

behavioral health approaches to the longstanding

challenges that occur at the intersection of crime,

substance use disorders, and mental illness. One

framework that court officials employ in adherence to the

responsivity principle is therapeutic jurisprudence.50 This

framework focuses on “ethics of care” within the judicial

system--e.g., the notion that lawyers and judges should act

with care, trust, and sensitivity.51 Responsive therapeutic

48 Latessa, Edward J. and C. Lowenkamp. “What are Criminogenic Needs and Why are they Important?” For the Record,

4th Quarter (2005): 15. 49 Andrews, Donald A., I. Zinger, R.D. Hoge, and J. Bonta. “Does Correctional Treatment Work? A Clinically Relevant

and Psychologically Informed Meta-Analysis.” Criminology, 28.3 (1990): 369. 50 Birgden, Astrid. "Therapeutic Jurisprudence and Responsivity: Finding the Will and the Way in Offender

Rehabilitation." Psychology, Crime & Law 10, no. 3 (2004): 283-95. 51 Ibid., 287.

Therapeutic Jurisprudence utilizes an interdisciplinary approach, capturing the expertise available within the fields of law, psychology, psychiatry, criminology, and public health, in order to increase the likelihood that designated therapies will strengthen the rehabilitative effects of adjudication.



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programs surround offenders with firm, fair, and empathetic staff members who model pro-social

behaviors in correctional settings that are conducive to offender rehabilitation.

Modern criminal justice policymakers should look to implement multidisciplinary strategies that

focus on broad-based, systemic intervention, and the application of minimum, but appropriate

amounts of supervision, sanctions, accountability, services, and resources to achieve intended

results.52 It is understood that the majority of offenders experience psychological distress upon the

commencement of a sentence, including involuntary treatment/diversion.

Therefore, it is important that therapeutic programs:

● Maximize the rehabilitative aspects of the law

● Place offenders in environment that enhance their well-being

● Enable offenders to make autonomous decisions about success goals

● Employ multidisciplinary/multi-agency approaches to rehabilitation

● Provide individualized treatment

● Provide normative or value-based cognitive-behavioral solutions

● Encourage strong individual-community balance

Therapeutic programs should take advantage of opportunities to motivate behavior changes.

Although there are no federal or state requirements to provide individualized treatment for

individuals in therapeutic programs, many of the nation’s leading therapeutic treatment programs

adhere to Risk-Need-Responsivity principles for treatment-matching, readily applying an evidence-

based practice to produce improved rehabilitative outcomes.

52 Ibid.


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Chapter 4 Comparative Program Models & Evaluative

Methods

4.1 Comparative Programs

The core question in evaluating mental health courts is not, ‘Do mental health courts work?’

but rather, ‘What works, for whom, under what circumstances?’ There is no single model of

intervention that will work for everyone. It is widely held that therapeutic courts should

determine the type of defendants that the court can have the most positive impact on in

terms of quality of life improvements, public health, and public safety.53

Effective programs internally and externally evaluate their treatment programs regularly. Section 4.1

is intended to demonstrate how local mental health courts evaluate their performance and overall

treatment effects by analyzing participant eligibility, policy implementation, and use of evidence-

based practices. Examples of both short- and long-term evaluative models are included.

Understanding how local therapeutic courts evaluate their performance will allow MAP staff to

prepare for the application of a standard evaluative method to assess the program’s unique impact

with greater internal and external validity.

Snohomish County District Court Mental Health Court

Context

In 2014, the Snohomish County District Court Mental Health Court (SCMHC) performed an

internal formative evaluation to measure the court’s ability to increase public safety, reduce

recidivism, and provide participants with access to mental health treatment services.54 SCMHC chose

to conduct a short-term evaluation, because many of the admitted participants had yet to graduate

from the program.

Although a short-term evaluation does not reveal information about clients’ long-term success, it

can still provide useful interim information for the MAP team. If MAP staff decide to evaluate the

short-term effects of the program, they may also want to share information and resources with

SCMHC, as they are in close proximity to one another.

53 Steadman, Henry J., A Guide to Collecting Mental Health Court Outcome Data. New York, NY: Council of State

Governments, 2005: 3. https://csgjusticecenter.org/wp-content/uploads/2013/05/MHC-Outcome-Data.pdf. 54

Fenn, Robin, Snohomish County District Court Mental Health Court, Summary Report, 2014.

http://snohomishcountywa.gov/DocumentCenter/Home/View/20622.


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Short-term Evaluative Model

SCMHC used a short-term pre-treatment/post-treatment evaluative design. The evaluative criteria

aimed to measure participants’ utilization of crisis services within Snohomish County over a six-

month to one-year period pre- and post-admittance. SCMHC outlined clear public safety and quality

of life metrics, including, but not limited to:

● Number of offenses for which a participant is arrested during the year prior to entry into MHC,

during the time in MHC, and for the year post MHC completion

● Type and severity of offenses for which a participant is arrested during the year prior to entry

into MHC, during the time in MHC and for the year post MHC completion

● Number of participants who are compliant with their medication

● Number of participants who improve their quality of life (e.g., obtained employment, school,

substance abuse treatment, housing).55

Admittance to SCMHC requires a Diagnostic and Statistical Manual of Mental Disorders, Fifth

Edition (DSM-IV) diagnosed mental disorder, so this data was also collected and analyzed.

Collecting information on participants’ specific illnesses leads to greater understanding of the

treatment interventions that work best.

The concise metrics SCMHC defined for this evaluation facilitated effective data collection. Having

an effective data collection system allowed SCMHC to measure several different positive outcomes

experienced by program participants. For example, during the six months after admission to the

program, emergency medical service utilization decreased 100 percent for clients. Moreover, in the

six months after their admission to program, the number of arrests decreased 100 percent for six

clients, remained constant for one client, and increased 50 percent for one client. Overall, arrests

decreased from 12 to five from the six months pre- to post-admission. In addition, 100 percent of

SCMHC clients were employed, an increase from zero percent, and 75 percent were housed post-

admittance, an increase from 25 percent.

Threats to the internal validity of SCMHC’s evaluation include the small number of individuals in

the treatment group (n=10), and the absence of a control group. In other words, there is no

measurement of recidivism outcomes for individuals who did not receive SCMHC admittance,

rejected SCMHC admittance, or were non-graduates. The lack of an adequate baseline, or control

group, against which to measure participant outcomes limits the internal and external validity of the

preliminary SCMHC evaluation.

Seattle Municipal Mental Health Court

Context

Seattle Municipal Mental Health Court (SMMHC) has a similar mission to SCMHC--improve public

safety and quality of life for participants, reduce incarceration and contact with the criminal justice

55 Ibid., 4.


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system for people with mental illness, connect participants with and increase their likelihood of

success in treatment.56 SMMHC released an evaluation of their court’s performance over a ten-year

period (1999 to 2011), which included annual program cohorts of five or more members. This long-

term evaluative model is included here in the event that MAP would like to pursue a longitudinal

evaluation of their program to measure results over a 24-month period or longer.

The SMMHC evaluation was designed to “describe benefits that mental health courts provide for its

participants and the larger community, and to identify ways that its processes can be strengthened

and outcomes improved.”57 For this reason, there are several findings from the evaluation that could

be relevant to MAP in preparation for conducting a future evaluation.

SMMHC programs are for offenders who have been charged with misdemeanors. Participants

whose psychological disorders (with the exception of people with mental retardation or personality

disorder, which are ineligible) contributed to their criminal behavior are eligible for the program.

Eligible participants must voluntarily agree to participate in the program. The number of SMMHC

participants during the evaluation period exceeded 800, and the average amount of time successful

participants spent in the program was 23 months. Over time, the time-to-graduation decreased,

primarily due to the SMMHC improving its ability to identify individuals who are ready for

rehabilitation and long-term change.

Long-term Evaluative Model

SMMHC used a longitudinal pre-treatment/post-treatment evaluative design. Demographics such as

age, race and gender were data utilized in the evaluation. Static risk factors, such as pre-admittance

criminal histories, were evaluated during program placement. Participants were referred to services

that could adequately mitigate their individual criminogenic needs. The evaluation measured

behavioral outcomes based on the following criteria, among others:

● Number of mental health service contacts, both crisis- and non-crisis, funded by King County

Mental Health, Chemical Abuse and Dependency Services Division;

● Number of days in the King County Jail system; and

● Number of contacts with Seattle Police (includes both arrest and other types of contact,

provided by Seattle Police Department).58

SMMHC also monitored participants’ level of participation in recommended treatment programs

and services.

The evaluation indicated significant quality of life improvements, especially for certain races and

genders. White participants and women completed the program at greater rates than other groups.

Despite demographic disparities, all participants who opted into the program increased their use of

56 Law & Policy Associates, Seattle Municipal Mental Health Court Evaluation, 2013.

http://www.seattle.gov/courts/pdf/MHReport2013.pdf. 57 Ibid., 5. 58 Ibid., 6.


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non-crisis services (mental health treatment, housing, and other services); thus, the program

achieved its goal of increasing participants’ use of mental health and social services.

Of those who completed the program, evaluation findings indicated that those who used more crisis

mental health services prior to admission were significantly less likely to succeed. When compared

with those who did not complete the program, those who completed the program also had far fewer

jail days before, during, and after program admittance. Regardless of completion or non-completion,

all participants experienced a decrease in police contact and carceral incidents after entry to the

program.

The internal and external validity of this study is strong, as SMMHC not only designed a pre/post-

treatment evaluation for those who completed the program, but also observed outcomes for those

who did not complete the program. Observing non-graduates provides an adequate comparison or

baseline group against which to measure outcomes of program participants. There were 846

participants included in this study and the results were statistically significant (p>0.02).


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4.2 Suggested Evaluation Model for MAP

If MAP would like to prepare for a longitudinal pre-treatment/post-treatment evaluation, the short-

and long-term evaluations outlined in Section 4.1 provide potential goals around which to collect

data. We customize those goals and metrics for MAP in this section.

First, an explicit definition of recidivism and how it will be measured is needed to standardize

documentation of program benefits and success prior to undergoing an evaluation. Data collection

for a long-term evaluation should include prior, present, and post-program arrests/incarcerations to

paint a fuller picture of recidivism rates.

To effectively measure MAP’s impact during a future evaluation, staff could begin collecting data

related to participants’ quality of life and public health, public safety, and recidivism by examining

the following metrics:

● The number of participants receiving social services prior to, during, and after program

admission;

● The number of MAP participants who were screened for risks/needs before receiving treatment;

● The number of charges and length of jail time MAP graduates and non-graduates had prior to,

during, and after program admission;

● The number of participants who attain/retain employment, education, and housing during and

after entry into MAP;

● The frequency of emergency service usage for MAP graduates versus non-graduates prior to,

during, and after entry into MAP; and

● Recidivism rates for MAP graduates and non-graduates.

A long-term evaluation should span a period of three to five years to ensure the sample size of

participants is sufficient, assuming current numbers of participants remains constant or increases. If

participant numbers decrease, then the number of years would need to increase to compensate for

this decrease in sample size. Analyzing data annually over a three to five-year period will allow MAP

staff to make inferences about the population best served by the program. This data will also capture

MAP’s impact on participants’ quality of life and recidivism, demonstrating the benefits the program

provides to citizens and emergency service providers in Everett.


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Chapter 5 Interim Evaluation of MAP

5.1 Advancing Correctional Excellence Risk Need Responsivity Tool

MAP is not currently suited to receive a summative evaluation, as the program has a small number

of participants, data collection is neither streamlined nor comprehensive enough, and staff did not

have access to the external data necessary to make a causal statement about MAP’s overall treatment

effect.

In the interim, we evaluated the current structure of MAP using the George Mason University

Center for Advancing Correctional Excellence Risk Need Responsivity (RNR) tool. The RNR tool

assesses a program’s usage of evidence-based practices to reduce recidivism. RNR results are

designed to help courts and other agencies evaluate and incorporate the practice of Risk-Need-

Responsivity principles during treatment planning and implementation.

RNR Tool Use and Design

The RNR tool assigns a program or specialty court to one of six groups based on the program’s

target population, types of participant risk/need data collected, and program intervention goals.

After this information is entered into the RNR tool, the program is categorized by its primary

intervention goal. The interventions are grouped below:

Group A- Dependence on Hard Drugs Group B- Criminal Thinking/Cognitive

Restructuring Group C- Self-Improvement & Management

Group D- Interpersonal Skills Group E- Life Skills Group F- Punishment Only

The results of the evaluation are based on the quality of the program, the accessibility of the

program, as well as the amount and types of controls used. The responsivity components of each

intervention group aim to reduce primary target behavior(s) using evidence-based practices and

responses catered to clients’ risk/need factors. In essence, the tool examines the program’s

intervention goal, content, and implementation. The final score is based on six criteria, listed below:

1. Risk 2. Need 3. Responsivity

4. Implementation 5. Dosage 6. Additional Features

The RNR tool then yields an overall percent reduction in recidivism that a participant can expect to

experience by completing the program.


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5.2 Current Conditions of MAP

Demographics & Intervention Category

As noted earlier, intervention categories are often based on the population being served. MAP was

categorized as Group C- Self Improvement & Management Program, because it serves individuals

suffering from mental health and/or chemical dependency disorders, repeat offenders, and

individuals with a history of trauma. The RNR tool notes that high-quality Self Improvement &

Management programs include some cognitive restructuring work for those with substance abuse

(marijuana or alcohol abuse) and/or mental health issues. MAP predominantly targets moderate-to-

high risk offenders and administers a recommended treatment plan, providing minimal oversight.

MAP currently serves about 32 participants. It includes offenders of varying risk levels. About 75

percent of MAP participants are between the ages of 18 and 35. Approximately 81 percent of

participants are Caucasian. There is gender parity, in that 50 percent of MAP’s participants are male

and 50 percent are female. Most participants enter the program after committing offenses such as

theft, trespassing, and other misdemeanor offenses due to a mental illness or chemical dependency

disorder.

Similar to most therapeutic courts, MAP participants are generally facing multifaceted problems

such as homelessness, mental illness, and substance abuse. In the words of one participant

interviewed, “Nothing on my plate totally gets solved. I don’t have a plate; I have a platter, and it’s

heapin’.” The difficulties in MAP participants’ lives are both complex and overlapping.

Structure of Responsivity

Participants are screened for MAP based on previous or current offense, legal condition, and/or

clinical/professional judgement. In MAP’s case, the assigned Judge Laura Van Slyck, decides

whether to accept participants. Administration of participants’ recommended treatment plan is

designed to improve their impulse control, aggression control, problem-solving skills, anger

management, mental health symptom management, and substance abuse disorder management.

The MAP Liaison refers participants to community-based service providers and monitors participant

compliance with stated treatment goals. Since treatment is not administered in-house and treatment-

matching for participants varies, consistency is compromised. Staffing-meeting observations

indicated that some clinicians play a more active role in setting up services for participants than

others. Aftercare is not provided.

Participants may attend court hearings up to two times per month and treatment as needed.

Participants are expected to be in weekly communication with the MAP Liaison; occasionally this

expectation is mandated.


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Use of Sanctions and Rewards

Various rewards and sanctions are associated with the program. According to our observations,

rewards include verbal praise, phase advancement, and graduation ceremonies. The literature around

rewards would likely not qualify a graduation ceremony as such, given it occurs at the end of the

program and is not uniquely catered to participants’ positive behavior or accomplishments.

MAP sanctions include verbal reprimands, increased treatment requirements, observation of jail

calendars, bench warrants, removal from program, jail time, and written assignments. From our

observations and interviews, the most commonly used sanction is essay writing. In observing several

MAP calendars, we noted that the use of sanctions and rewards is not standardized according to

particular behaviors or programmatic phases. Possible sanctions and rewards are also not specified

in MAP protocol, and no exhaustive list exists elsewhere, to our knowledge. The judge retains great

discretion in determining sanctions and rewards, resulting in a large amount of flexibility. While

judicial discretion is paramount, we are concerned with the lack of consistency in sanctions and

rewards given across program participants. According to our calendar observations and interviews

with participants, however, this can be a stressful and difficult assignment to complete for someone

who might be lacking a high school-level education and/or faces mental health problems. Another

sanction includes attendance of sober support groups for participants failing to comply with

chemical dependency-related orders. As stated in MAP’s Protocol document:

Consequences may include judicial reprimands, increased frequency of treatment sessions or contact

with treatment provider, increased court appearances, community service, electronic monitoring,

curfew, incarceration, or removal from the program and proceeding to a finding on the original

charge(s).

However, according to the National Association of Drug Court Professionals, “Treatment

adjustments should be based on participants’ clinical needs as determined by qualified treatment

professionals, and should not be used to reward desired behaviors or to punish undesired

behaviors.”59 The danger in using treatment as sanctions may result in participants attributing

treatment to punishment and reduces the likelihood of sustained treatment.

Data Collection

Data collection must be a unified comprehensive database that houses participant demographics,

enrollment, progress, and attrition data to provide future evaluators with accurate and ample data to

analyze. MAP currently lacks explicated quality of life and public safety metrics (e.g., data about

clients’ impact on emergency services, client job attainment/retention, and client arrest detentions).

Using evidence-based practices geared towards achieving measurable success in public safety and

quality of life outcomes would provide data that demonstrates what participants are best for MAP

and what makes an intervention plan successful.

59 National Drug Court Institute. “List of Incentives and Sanctions.” National Drug Court Resource Center. http://www.ndcrc.org/content/list-incentives-and-sanctions.


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Due to their current data collection processes, we sought out guidance from Snohomish County’s

District Court Program Coordinator Janelle Sgrignioli. Her staff uses Drug Court Case Management

(DCCM) software developed specifically for therapeutic court programming. DCCM software

permits user-specific role-appropriate authorization for clinicians, judges, attorneys, social workers,

and other necessary parties to access, edit and maintain program participant profiles. We assume that

in time, the usage of data collection software will become an available resource for MAP.

Staffing Meetings

The current MAP meeting structure is dependable. However, the absence of a judge, participants’

legal counsel, and/or a service provider can lead to inappropriate reward/sanction

recommendations, inconsistent treatment monitoring, and/or information asymmetry. We believe

that asking the judge or a service provider to sit in on a MAP staff meeting once a month is an

opportunity for MAP staff to incorporate feedback from individuals who have final decision-making

authority regarding participant treatment and sanctions. Including this feedback will lead to

consistency in participant experience and provide better outcomes in the long-term.

Referral Process

Our interviews with MAP staff revealed a widespread desire to amend the MAP referral process

through several reforms. The RNR tool described in Chapter 5 indicated MAP staff could improve

the referral process by reducing the amount of time participants spend in the Observation Phase.

This suggestion was echoed by MAP staff, as well. Currently, the Observation Phase can last at least

six weeks, which results in a significant loss of potential candidates as individuals drop off during

this long time period. Shortening this window could capture a population of higher-risk participants

who may not be in as stable a position to wait around for six weeks, remembering to attend

mandatory calendar observations, in order to enter MAP.

Additionally, the instances of inappropriate referrals seem to stem from a combination of a lack of

education and understanding that exists around the referral process. If the process was made clearer,

this problem would potentially disappear. Further, while being in custody at the time of referral does

not make MAP candidates ineligible to participate, it is particularly difficult to schedule intake

meetings with these individuals to gather the information required to join. For this reason, there has

never been a single successful referral of someone in custody to MAP. Currently, there is a great deal

of inefficiency and time wasted around the fact that the defense attorney is inundated with referrals

that do not result in MAP participation.


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5.3 MAP’s RNR Results

As mentioned earlier in this chapter, the RNR program evaluation is based on MAP’s ability to

assess risks, treat offender needs, provide responsive care, implement their program with fidelity,

recommend adequate treatment dosages, and customize treatment goals for their clients.

Using the RNR tool is challenging for a program like MAP that depends on community-based

services, as services available may or may not be consistent with the risks/needs of offenders.

Risk/Need

The results indicate that MAP performed in the lower 20th percentile at determining offender risk

levels, as it does not currently use a validated offender risk assessment to determine participant

eligibility. MAP also performed in the lower 20th percentile at targeting criminogenic needs with

fidelity because it does not use a target-specific needs assessment.

Improvements can be made by using a validated risk assessment tool, targeting one criminogenic

need, focusing on mitigating one primary target behavior, and using target-specific diagnostic criteria

or a validated needs assessment (or ensuring that community-based treatment service providers use

one).

Responsivity

MAP performed in the top 20th percentile in responsivity, which is arguably one of the most

important aspects of rehabilitation programs. Responsivity is the nexus between treatment-

matching, service delivery, and program controls. MAP scored very high in this category due to its

wide use of community-based behavioral health interventions under moderate-to-high intensity

supervision.

Improvements to MAP’s performance can be made by

using evidence-based practices (e.g., matching

clients to specific modules used), including gender-

specific programming, limiting the number of

behaviors that earn rewards, and providing

more intensive supervision with drug tests

and counseling.

Dosage and Implementation

MAP performed in the top 50th percentile in

implementation and dosage. Test results indicated that

MAP could benefit from standardizing the data shared

between clinical staff and MAP staff, incorporating

external evaluations, and using a treatment manual or

curriculum.

Dosage refers to the amount of clinical hours and frequency of client-supervisor contact--e.g., high-ranking Self-Improvement & Management programs require 200 clinical hours, 18 or more weeks of mandatory/monitored weekly treatment, 10 or more hours of treatment per week. Not all criteria listed are applicable.


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Improvements related to MAP’s ability to supervise

implementation and dosage would include basing

completion criteria on improvement of

participants’ criminogenic symptoms rather than

focusing on attendance or length of program.

Restrictiveness

MAP performed in the top 99th percentile in restrictiveness

due to its use of phases, supplemental services, and

community-based programming. Based on the RNR tool’s

results, MAP participants who complete the program should

experience a 53 percent decrease in their likelihood of

recidivating (see Appendix E for full RNR Program Evaluation

Tool Results).

MAP scored so well that the RNR tool offered few suggestions

for improvement.

Implementation refers to completion criteria, treatment and supervision, levels of communication between staff and clients, use of external program audits, as well as having staff members who are clinically certified or hold degrees in a relevant field. Not all criteria listed are applicable.


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Chapter 6 Recommendations

The majority of MAP participants we interviewed have overwhelmingly benefitted from their

involvement in the program. The following quotes from participants describe the many positive

outcomes they have seen from MAP.

“[MAP staff] have been a major factor in my recovery and turnaround. I look forward to

meeting with Cathy.”

“I think they definitely helped me accomplish my goals…with their guidance and the tools

they gave me, so that I have a better program, learn how to cope…in society.”

“[MAP staff] are wholeheartedly behind you. I have been doing a lot of things on my own

now.”

However, there are opportunities to improve the program for the minority of participants who do

not attain these same benefits. There is also an opportunity for MAP to consider how to reach those

people with misdemeanors who are never able to successfully enter the program for a variety of

reasons. It may be that the participants with favorable experiences and perspectives of MAP were in

a better initial position to enter in the program over others. It may also be that they entered the

program with a greater sense of self-determination and motivation than their peers. The words of

other participants seem to support these hypotheses:

“You have to want to do it for yourself, not for them.”

“If you do not have a foundation to grow from…you’re going to fall…[MAP] could

probably be a little bit harder.”

Regardless of why some MAP participants are more successful than others, it is crucial for the MAP

team to analyze and understand points of potential improvement in the program like this and others.

To address the points of improvement that exist within MAP, we have six recommendations.

First, we recommend the MAP team begin to develop or procure a comprehensive data collection tool to

record details necessary for a future program evaluation.

If MAP staff utilized a single information gathering system, data collection efforts would be

streamlined and duplication of effort would be prevented.

MAP staff both at the court and Bridgeways could easily access holistic information on

program participants as needed.


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We suggest amending the referral process to facilitate increased referrals to the program and increase efficiency

and accuracy of the process. We recommend increasing outreach and education around eligibility criteria,

as well as frontloading paperwork involved in participant assessment.

If agencies making referrals were equipped with something such as a decision tree of

eligibility criteria, there would be a substantial decrease in referrals of people who are not

eligible for the program. The result would be significant recuperation of time lost filtering

through inappropriate referrals on the defense attorney’s behalf.

Frontloading and streamlining assessment paperwork for potential MAP participants during

the referral process will save both the defense attorney and MAP Liaison time down the line.

To aid in this process, we have developed a handbook in association with the MAP Liaison

that should be given to participants, upon referral, located in Appendix G.

MAP’s presiding judge and treatment providers should attend bi-weekly Staffing.

Staffing attendance of all decision-making players involved with MAP would allow for more

individualized treatment plans, rewards, and sanctions to be created for participants.

Information currently lacking on many participants’ progress due to lack of direct

communication between treatment providers and the MAP Liaison could be provided.

Involving all key stakeholders in participants’ success would lead to more structured,

informed, and appropriate treatment plans and use of rewards and sanctions.

Roles of MAP staff members should be revisited and redefined together as a team.

Not only is there duplication of effort from our observations and interviews with the MAP

team, but there also appears to be some misallocation of responsibility. In particular, the

judicial clerk seems to have a great deal of discretionary power around determining sanctions

and rewards for participants during Staffing.

Following this recommendation would also be an ideal opportunity to gather the MAP team

together for the quarterly staff meeting that multiple team members voiced interest in seeing

come to fruition.

We recommend compiling an exhaustive list of possible rewards and sanctions MAP participants

can receive.

Creating a list of rewards and sanctions would ensure everyone on the team is making

decisions as to how to react to positive and negative participant behaviors using the same set

of standards. We have provided examples of what these lists may include, modeled off those

used by SCMHC, in Appendix F.


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Conducting Staffing with a comprehensive list of rewards and sanctions in front of the team

could potentially trigger more creative decision-making, resulting in a wider variety of

rewards and sanctions used.

Diversifying rewards and sanctions will benefit participants by keeping them engaged with

the program.

Finally, in the long-term, we suggest the MAP team collaboratively determine whether the program should

follow a drug or mental health court model.

Currently, MAP exists in a gray area that allows the program a great deal of flexibility and

discretion. However, adhering to either drug or mental health court standards would

improve standardization of the program’s processes and outcomes. Doing so would provide

the rigorous framework and structure necessary to prepare MAP for a future evaluation.

Abiding by either drug or mental health court standards would also permit the program to

apply for larger pools of funding for the program from state and national institutions.


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Conclusion

Many of the aforementioned challenges are also opportunities for MAP staff to improve the quality

of their program. One of the most important ways for MAP to improve immediately is by

holistically collecting data for all participants, centralizing collection. Without collecting data, MAP

staff lacks the ability to make any causal statements about the effects of the program. Additionally,

consistency remains key to make definitive claims regarding effects of the program.

MAP has the capacity to provide a wealth of future research opportunities due to the unique

attributes of Everett, Snohomish County and the structures MAP has in place. Future possibilities

for research opportunities include:

Who gets into the program and who may be getting missed?

Do the demographics of the program mirror those of the general jail population?

Further, who is successful in the program? Are there trends of a particular kind of person

being successful over another? What are the safety and health determinants of success in the

program?

What is the rate of recidivism?

We anticipate that there will be a need for additional funding in the future. The caveat remains that

without ascribing to set model standards, MAP will not have access to the depth of funding offered

to therapeutic court systems, nor will they be able to measure themselves against their peers.


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Appendices

Appendix A MAP Organizational Chart


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Appendix B MAP Theory of Change


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Appendix C MAP Eligibility Criteria

1. There must be a basis for finding that the person would benefit from the program.

2. A person charged with any of the following offenses is presumed ineligible: DUI, Physical

Control, Communicating with a Minor for Immoral Purposes, any Domestic Violence (DV) crime

where the prosecutor has determined that the victim is objecting, and any offense during which

defendant used a firearm or caused substantial or great bodily harm or death to another person.

3. A person is not eligible if he/she has previously been convicted of a serious violent offense or sex

offense as defined in RCW 9.94A.030.

4. When a person is charged with a violent crime or when the person has a history of violent crime,

he/she will not be eligible for the MAP until the MAP Liaison 2 has:

a. Received and reviewed a professional assessment of issues such as mental illness or

chemical dependency that may have contributed to the criminal conduct;

b. Reviewed the proposed treatment plan for the person;

c. Determined the person’s eligibility for publicly-funded treatment or demonstrated

ability to pay for private treatment; and

d. Recommended acceptance into the program

5. A person must be competent as defined by state law in order to participate in the MAP.

6. A person who presents a safety risk to the MAP Team or any specific participant is presumed

ineligible. This includes individuals who are respondents in any court orders prohibiting contact with

any member of or participant in MAP.


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Appendix D MAP Phase Requirements


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Appendix E RNR Program Evaluation Tool Results


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Appendix E RNR Program Evaluation Tool Results Continued


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Appendix F Examples of Sanctions and Rewards

Achievements

Rewards

Attendance to:

o court appearances o drug testing o participation & engagement in

treatment o chemical dependency/sober support

meetings Honesty Follow through and engagement with

ancillary services (e.g. Mental health) Housing Restitution Progress in Education Completion of GED or High School Diploma College enrollment or attendance Progress in Employment Positive feedback from community Participant specific goals

Recognition and Praise by the Judge Certificates of achievements

Gift Cards Movie/Event Passes Decreased court appearances Stage Advancement Expedited in court Books Trip Requests Granted

Violations

Sanctions

o Dishonesty o Forgery o Missed court appearances or sober support

meetings o Missed or Unable to Provide UA tests

(considered a positive) o Positive UA test (positive for

drugs/alcohol/Dilute) o Adulterated/Tampered UA test or

Missed treatment o Inappropriate behaviors at treatment o Non-compliance with treatment plan o New criminal charges o Driving while license suspended/revoked o Failure to perform/complete sanctions o Violation of court order o Housing o Failure to: update & submit information/paperwork w/

the court obtain high school diploma, GED,

employment

o Reprimand from the Judge o Verbal Warning from the Judge o Increased court appearances o Community Service Work o Work Crew o Jail o Writing Assignment o Budget/Expense breakdown and justification o Life Skills Assignment o Letter of Apology o Team Roundtable o Termination


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Appendix G Participant Handbook

See following page for the beginning of the document.

MAP Public Service Clinic Project

Documents

Transcript of MAP Public Service Clinic Project