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

This is a drug treatment court that seeks to reduce rearrests and reconvictions for drug-involved individuals with substantial criminal and drug addiction histories. The program is rated Effective. Compared with the control group, program participants had a statistically significant fewer number of arrests at the 24-month and 15-year follow up, but not at the 36-month follow up. Participants also had a statistically significant fewer number of total convicted charges at the 15-year follow up.

An Effective rating implies that implementing the program is likely to result in the intended outcome(s).

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

Program Goals

The Baltimore City Drug Treatment Court (BCDTC) was created in 1994 in response to a report by the American Bar Association (ABA), which found that nearly 85 percent of all crimes committed in Baltimore, Maryland were addiction driven (Bar Association of Baltimore City 1990). The objective of the BCDTC is to identify individuals with drug addiction and offer them a treatment alternative to incarceration. The four main goals of the BCDTC are to 1) provide pretrial, drug-dependent detainees with close supervision; 2) allow judges to use a cost-effective sentencing option by providing a fully integrated and comprehensive treatment program; 3) reduce recidivism rates of crimes committed by drug-motivated individuals; and 4) facilitate the academic, vocational, and prosocial skill development of participants.

Target Population/Eligibility

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

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

Program Components/Program Theory

The BCDTC program consists of four main elements: intensive probation supervision, drug testing, drug treatment, and judicial monitoring. Drug court models are based on the presumption that if individuals stop using drugs and alcohol at abusive levels, then there will be sustained reductions in or desistance from criminal activity and improvement in other life outcomes (Kearley and Gottfredson 2019). Thus, while under intensive supervision, individuals must adhere to three face-to-face meetings with their probation officers per month, two home visits, and a verification of employment status. Probation officers also frequently monitor an individual’s criminal record for violations. After a sustained period of compliance, an their level of supervision can be downgraded from “intensive” to “standard high.”

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

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

Finally, judicial monitoring takes place in the form of frequent status hearings. The judge reviews reports from treatment providers and probation officers at these hearings to determine an individual’s compliance with the program. Failure to comply with program requirements can result in a variety of sanctions, including increased status hearings, increased drug testing, and curfews. More severe sanctions may include home detention, temporary incarceration, and community service. If a participant displays extreme noncompliance with the program, the judge can re-impose the original sentence, which can often be more severe than if the sentence had been imposed under traditional adjudication. To graduate from the program, participants must be employed, complete 20 hours of community service, participate in the program for a minimum of 12 months, and have at least 9 months of clean urine samples.

Key Personnel

In a drug treatment court, a judge, program coordinator, assistant state’s attorney, assistant public defender, and parole and probation officers offer treatment services, while maintaining the punitive focus of the criminal justice system.

Study

Gottfredson and colleagues (2003) used an experimental design to test the effectiveness of the Baltimore City Drug Treatment Court (BCDTC) to reduce crime among severely drug-addicted populations. The study looked at the outcome results of 235 individuals randomly assigned to BCDTC or to a treatment-as-usual control group, from February 1997 to August 1998, over a 24-month follow up period. Study participants were identified and referred by Baltimore Court personnel if they met the following criteria: 1) were at least 18 years of age, 2) resided in Baltimore City (Md.), and 3) did not have any past or current convictions for violent offenses.

Treatment group participants were processed in a court that implemented the drug treatment model. Those in the control group underwent the adjudication process in a traditional court, without treatment services. There were 139 people in the treatment group, of which 89.2 percent were African American, 74.1 percent were male, and had an average age of 34.8 years. The control group consisted of 96 individuals who were 89.6 percent African American, 74 percent male, and had an average age of 34.7 years. There were no statistically significant differences between the groups at baseline. Although they were randomly assigned, records indicated that only 91 percent of the treatment group participated in the BCDTC, and 7 percent of the control group assigned to treatment as usual also participated in the BCDTC. The reasons for these mis-assignments were not known; however, the study authors speculated that they may be due to judicial overrides of the randomization process and clerical errors. As a result, the study authors used an intent-to-treat (ITT) analysis, which means that the study participants were treated as randomized, regardless of their actual treatment. This strategy was adopted to preserve the comparability of study groups.

Outcomes of interest were measured through various recidivism reports of rearrests, reconvictions, at least one new drug charge, number of new arrests, number of new charges, and number of new convictions over a 24-month period following the date of randomization. Outcome data were collected from the Maryland Department of Public Safety and Correctional Services and the Baltimore Substance Abuse Services (BSAS), an organization that coordinates drug treatment services in Baltimore. The collected information included demographic characteristics and prior offense history, as well as information on recidivism, drug treatment, drug testing, probation supervision, judicial monitoring, and time spent behind bars over 24-months. The study authors used chi-square tests and t tests to compare the BCDTC participants with control group members. The study authors did not conduct subgroup analyses.

Study

Gottfredson and colleagues (2005) conducted a follow up evaluation to Study 1 (Gottfredson et al. 2003) to examine the long-term effects of the BCDTC model. The study authors conducted interviews with 157 of the 235 original Study 1 participants, which was 3 years after they were randomly assigned to either the drug treatment court (n = 93) or the treatment-as-usual control group (n = 64). Participants’ demographic characteristics were the same as the sample in Study 1. In this study, interviews took place between February 2000 and November 2001, and each lasted approximately 90 minutes. There were no statistically significant differences between the interviewed group and the non-interviewed group, except in recidivism. At the 3-year follow up, the interviewed group had more arrests, compared with the non-interviewed group. This finding reflects the fact that jails and prisons were reliable locations to find individuals who were otherwise difficult to track.

Outcomes of interest were recidivism, maximum crime seriousness, crime variety, severity of alcohol and drug addiction, employment, and global mental health severity. Data were collected using the past 12 months as a reference period and at the 3-year follow up. However, employment was measured at the immediate time of the interview. Recidivism was measured by arrests reported through official records. Maximum crime seriousness and crime variety were defined through criminal activity using two scales: the Maximum Crime Seriousness Scale, which combines data regarding 10 property, public order, and violent crimes (with each crime given a numeric value based on the severity of the offense) and the Crime Variety Scale (based on the same 10 crimes), which produces a score based on the total number of different types of crime an individual committed. Alcohol and drug use was measured using three scales, including the Alcohol Addictions Severity Scale (15 questions), the 13-item Drug Addiction Severity Scale, and the Drug Variety Scale (which combines data for 13 drugs/drug types and produces an aggregated score of different drugs/drug types consumed by the individual). Finally, the Brief Symptom Inventory (BSI) Global Mental Health Severity Scale measured the participant’s current level of symptomatology relating to a host of psychological disorders, including somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism.

The study authors used chi-square tests and t tests to compare the drug court and control group members. In instances in which multiple tests were conducted on a single measurement (i.e., criminal activity and drug use), a Bonferroni adjustment was performed. An ITT analysis was conducted to preserve the comparability of the treatment and control groups. The study authors did not conduct subgroup analyses.

Study

Kearley and Gottfredson (2019) conducted a follow up evaluation to Study 1 and Study 2 (Gottfredson et al. 2003; 2005) to examine longer-term effects of the BCDTC model across a 15-year period, as well as the impact of court case assignment (Baltimore City District Court versus Baltimore City Circuit Court). Study authors used the same samples from Study 1 and Study 2 that randomly assigned participants to receive either BCDTC services (n = 139) or treatment as usual in the traditional court (n = 96). The BCDTC treatment group consisted of 139 individuals(84 people who had their cases processed in the District Court and 55 whose cases were processed in the Circuit Court). There were 96 participants in the treatment-as-usual control group (42 individuals had their cases processed in the District Court and 54 had their cases processed in the Circuit Court). All 235 participants were included in interviews at the 15-year follow up.

At intake, treatment group participants averaged 12 prior arrests and 5.3 prior convictions. The majority of the treatment group participants had a current offense charge as a result of a drug crime (71.2 percent), followed by property offense (20.9 percent), public order offense (10.8 percent), prostitution or solicitation (5.8 percent), violation of probation (2.2 percent), or violent or sex offense (1.4 percent); less than 1 percent had a weapons offense (0.7 percent). Control group participants averaged 11.3 prior arrests and 4.6 prior convictions. The majority of the control group participants had a current offense charge as a result of a drug crime (71.9 percent), followed by a property offense (18.8 percent), public order offense (4.2 percent), prostitution or solicitation (4.2 percent), violation of probation (4.2 percent), violent or sex offense (4.2 percent), or weapons crime (3.1 percent). Demographic characteristics (i.e., race and gender) of the total sample were the same as in Study 1 and Study 2. There were no statistically significant differences between treatment and control groups.

Follow up data were collected at the 15-year period from official records as previously mentioned in Study 1 (Gottfredson et al. 2003), from the Maryland Department of Public Safety and Correctional Services and BSAS. Recidivism outcomes of interest at the 15-year follow up included 1) total arrest charges, 2) drug charges, 3) unique arrests (i.e., instances in which arrests do not necessarily lead to the same number of convictions), 4) total number of convicted charges, 5) convicted drug charges, and 6) unique arrests resulting in at least one conviction. All recidivism outcomes were measured cumulatively across the 15-year period and for each year of the follow up.

Negative binomial regression estimates were used, controlling for race, gender, age at randomization, and the number of prior convictions indicated in official records, to determine group differences on outcomes of interest over the 15-year follow up between BCDTC and control conditions The study authors conducted subgroup analyses within the treatment and control groups to determine whether court case assignment (District Court versus Circuit Court) impacted recidivism outcomes.

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

Subgroup Analysis

In regard to subgroups, Kearley and Gottfredson (2019) separated treatment and control participants into subgroups based on the type of court case assignment (District/Misdemeanor Court = 0; Circuit/Felony Court = 1) to determine subgroup differences for two cumulative recidivism outcomes: 1) total unique arrest convictions, and 2) total charge convictions. For both recidivism outcomes, the results showed that there were no statistically significant differences between BCDTC participants referred from the Circuit Court, BCDTC participants referred from the District Court, and control group participants.

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

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

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

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

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

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

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

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

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

https://npcresearch.com/wp-content/uploads/Baltimore_City_District_10_Year_Outcome_Cost_06092.pdf

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Evidence Ratings for Outcomes

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Evidence Ratings for Outcomes

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Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?