Program Profile: Juvenile Drug Courts With Contingency Management and Multisystemic Therapy

This program incorporates contingency management protocols and multisystemic therapy into traditional juvenile drug court services to provide juveniles and families with additional engagement opportunities and support to reduce recidivism and substance abuse. The program is rated Promising. The program statistically significantly reduced alcohol and poly drug use, positive drug urine screens, status offenses, and property offenses. The program had mixed effects on marijuana use and offenses.

A Promising rating implies that implementing the program may 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

Juvenile drug courts are problem-solving courts for cases involving substance-abusing juveniles in need of specialized treatment services. The emphasis is on providing treatment to eligible, drug-involved juveniles with the goal of reducing recidivism and substance abuse. The addition of the contingency management protocol and multisystemic therapy provides juveniles and families with additional engagement opportunities and support to improve the juvenile’s behavior.

Program Components/Services Provided

Juvenile drug courts are administered by a team of professionals, including court personnel (such as judges) and other treatment and social service providers. Juvenile drug court programs involve drug testing, ongoing case management, and weekly status hearings. In addition, treatment providers work closely with juveniles and their families to target substance use and related problem behaviors.

Contingency management is a threefold process consisting of 1) addressing the target behavior or behaviors, 2) providing tangible reinforcers when those behaviors are exhibited, and 3) removing incentives when those behaviors are not shown (Petry 2000).

Integrating the contingency management protocol with juvenile drug court services includes several components. The first component is the use of validated instruments and clinical interviews to determine the extent of the juvenile’s substance use. The scale ranges from experimental use to abuse/dependency. If the juvenile’s substance use is measured toward the latter end of the scale, he or she is introduced to the contingency management protocol and referred to treatment services.

At that time, a therapist employed by a community-based service provider collaborates with the juvenile and parents/guardians to analyze the juvenile’s substance use behaviors. Referrals are made to self-management and drug refusal skills training, then the juvenile and parents/guardians create a contingency contract to outline rewards for negative substance screens and consequences for positive ones.

Contingency contracts include a list of reasonable rewards for abstaining from substance use. These include incentives such as Internet access, a later curfew, or gift cards to stores or restaurants. A voucher system with levels and points is assigned to the list of incentives to encourage juveniles to abstain from substance use. Points are earned or lost based on drug screens and can be redeemed for rewards at any time.

At program completion, the therapist works with the juvenile and parents/guardians to create an aftercare plan.

Multisystemic therapy enlists the support of family members in the treatment process. The juvenile drug courts incorporate key therapeutic elements and skills building of multisystemic therapy into their creation and implementation of treatment programs. Key strategies include juvenile and family collaboration in the development of treatment goals, conceptualizing interventions to meet those goals, maintaining a nonblaming stance, and incorporating skills such as empathy, reflective listening, and flexibility. The overall goal of multisystemic therapy is to keep juveniles who exhibit serious problems—such as criminal behavior—at home, in school, and out of trouble. Juveniles are treated in the environments where their problem behaviors exist (i.e., home, school) rather than in an unfamiliar environment (i.e., custody) to enable change.  

Study 1

Henggeler and colleagues (2006) conducted a randomized experimental design with intent-to-treat analysis to evaluate the impact on substance use, criminal behavior, incarceration, and symptomology of various interventions integrated into three juvenile drug courts (JDCs) in Charleston County, S.C.

The study population was recruited from the South Carolina Department of Juvenile Justice. The final sample consisted of 161 substance-abusing and -dependent juveniles (according to the DSM–IV, Fourth Edition), ages 12 through 17. Youths were excluded if they were already formally involved in substance abuse treatment or if a family member had already received Multisystemic Therapy (MST) treatment.

Selected persons were randomly assigned to one of four treatment conditions: 1) family court with community services (FC), 2) drug court with community services (DC), 3) drug court with MST (DC/MST), and 4) drug court with MST enhanced with contingency management (DC/MST/CM). No nontreatment comparison group was included in the study. Assessments were conducted at three points in time: pretreatment, 4 months following treatment, and 12 months following treatment.

Sample youths were on average 15.2 years old and predominantly male (83 percent) and African American (67 percent). Another 31 percent were white, and 2 percent identified as biracial. Youths averaged 3.6 arrests before entering the study. There were no significant differences between groups at pretreatment.

Substance abuse was measured through self-reports and biological indices (drug urine screens from the three drug courts). Because of low positive screens for cocaine and amphetamines, analysis focused solely on cannabis use. Criminal behavior was assessed through self-reports and arrest records. Mental health symptoms were assessed through youth and caregiver reports. Data was analyzed looking at the effects at 12 months following recruitment.

Study 2

Henggeler and colleagues (2012) conducted a randomized experimental design with intent-to-treat analysis to evaluate the impact of JDCs with the contingency management­–family engagement intervention (CM–FAM) on substance abuse and criminal behavior.

Six JDCs were used in the study. Three were randomly selected to receive training and support to implement CM–FAM for 18 months, and the other three were randomly selected to deliver their treatment as usual. Juveniles in JDCs were referred from juvenile justice authorities, family court, or county departments of mental health and social services. For participation, juveniles had to be between 12 and 17 years old, be on formal or informal probationary status, and speak English fluently.

Juveniles in the study did not differ in their demographic or diagnostic characteristics. Participants were, on average, 15.4 years old, mainly male (83 percent), and mostly white (57 percent). Another 40 percent were African American, 3 percent identifying as biracial. Final analyses included data from 104 juveniles, with 63 juveniles in the CM–FAM condition and 41 juveniles in the treatment-as-usual condition.

Juvenile outcomes were measured using self-reported substance use and delinquent behavior at baseline, and at 3, 6, and 9 months after recruitment. Urine drug screens were collected at random times weekly. Self-reported substance use was evaluated using a timeline follow-back methodology for the previous 90 days at the time of survey. Analyses were performed using mixed-effects regression models.

Sheidow and colleagues (2011) conducted a cost-effectiveness analysis of the study by Henggeler and colleagues (2006), which examined the impact of juvenile drug courts with multisystemic therapy and contingency management (DC/MST/CM), compared with traditional family court (FC) and traditional drug court services, (DC) on substance use and criminal behavior. A cost-effectiveness analysis can determine whether the improved outcomes of DC/MST/CM compared with FC and DC are worth the increased expense of treatment. The average cost per case was determined by summing all the program costs (i.e., drug court costs, multisystemic therapy costs, and contingency management costs) and dividing it by the number of cases treated in a year. The analysis showed that the DC/MST/CM group was the most costly approach, with an average treatment cost of $12,994 per case over a 12–month period. The average treatment cost per case for DC with community services was $9,178, while the average cost of treatment for FC was $3,178 per case over 12 months. Results indicated that cost-effectiveness improved with the increasing intensity of interventions used. Although the treatment for DC/MST/CM was the costliest, the study authors argued that the combination of juvenile drug court with evidence-based treatment (i.e., MST and CM) was broadly cost-effective in reducing juveniles’ substance use and delinquent behavior. However, the FC option did affect the juvenile’s marijuana use and theft, and was less costly than the DC and DC/MST/CM options. Although the FC and DC options’ average costs were less than the DC/MST/CM option upfront, the impacts of DC/MST/CM on substance use and criminal behavior translated to a cost-effective return on investment in terms of criminal incidents avoided and costs associated with treating substance use.

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

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

Henggeler, Scott W., Jason E. Chapman, Melisa D. Rowland, Colleen A. Halliday–Boykins, Jeff Randall, Jennifer Shackelford, and Sonja K. Schoenwold. 2008. “Statewide Adoption and Initial Implementation of Contingency Management for Substance Abusing Adolescents.” Journal of Counseling and Clinical Psychology 76(4):556–67.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2603081/

Petry, Nancy M. 2000. “A Comprehensive Guide to the Application of Contingency Management Procedure in Clinical Settings.” Drug and Alcohol Dependence 58(1–2):9–25.

Sheidow, Ashli J., Jayani Jayawardhana, W. David Bradford, Scott W. Henggeler, and Steven B. Shapiro. 2012. "Money Matters: Cost-Effectiveness of Juvenile Drug Court With and Without Evidence-Based Treatments." Journal of Child and Adolescent Substance Abuse 21:69–90.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3290130/

Following are CrimeSolutions-rated programs that are related to this practice:

Juvenile Drug Courts

Juvenile drug courts are dockets within juvenile courts for cases involving substance abusing youth in need of specialized treatment services. The focus is on providing treatment to eligible, drug-involved juveniles with the goal of reducing recidivism and substance abuse. The practice is rated Promising in reducing recidivism rates, and No Effects for reducing drug-related offenses or drug use.

Evidence Ratings for Outcomes

	Crime & Delinquency - Multiple crime/offense types
	Crime & Delinquency - Drug and alcohol offenses
	Drugs & Substance Abuse - Multiple substances

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