Adult Treatment Court Best Practice Standards, 2nd ed.

I. Target Population
Treatment courts are most effective and cost-efficient when they serve high-risk and high-need persons who require an intensive combination of treatment and supervision. This finding has been reported in all treatment court models examined to date. The definition of high need has, therefore, been broadened to apply to all adult treatment courts and includes not only a compulsive substance use disorder but also a serious and persistent mental health or trauma disorder and other significant treatment or social service needs, such as traumatic brain injury, insecure housing, or compulsive gambling.

Treatment courts are also discouraged from imposing unwarranted admissions requirements that do not improve outcomes or protect public safety and disproportionately exclude members of some sociodemographic or sociocultural groups.

II. Equity and Inclusion
Ensuring equitable access, services, and out­comes for all sociodemographic and sociocul­tural groups is a critical obligation of treatment courts. Research conducted in the past decade provides substantial guidance for treatment courts to monitor and rectify unwarranted cul­tural disparities. Examples of effective practices include removing invalid eligibility restrictions that needlessly exclude some cultural groups, engaging in proactive and culturally congruent outreach efforts, delivering culturally proficient treatments and complementary services, and avoiding monetary or other resource require­ments that do not improve outcomes or protect public safety.

III. Roles and Responsibilities of the Judge
Research underscores the critical impact of the judge in all treatment court models and for all sociodemographic groups examined thus far. Although biweekly court status hearings (every 2 weeks) produce superior outcomes in the first phase of adult drug courts, new evidence sug­gests that weekly hearings may be required in the first phase for participants needing greater structure and consistency, such as persons with a co-occurring mental health and substance use disorder or those lacking stable social supports. Studies of procedural fairness also offer up­dated guidance to help treatment court judges enhance participants’ motivation for change, provide needed support and encouragement, avoid shaming, stigmatizing, or retraumatizing participants, and enhance sociocultural equity.

IV. Incentives, Sanctions, and Service Adjustments
Delivering fair, effective, and safe responses for participant performance is critical for success­ful outcomes in treatment courts and one of the most difficult challenges for staff. Careful guidance is provided to help staff classify the difficulty level of participants’ goals, and to deliver incentives or sanctions to enhance their attainment of achievable (proximal) goals and service adjustments to help them develop the skills and resources needed to achieve difficult (distal) goals. Cautious advice is provided to help treatment courts avoid serious negative side ef­fects from the misapplication of high-magnitude sanctions, especially jail detention, and prac­tical suggestions are offered to help programs deliver a creative range of low-cost incentives to maximize success. Finally, an example of an evidence-based phase structure with appropri­ate phase advancement criteria is provided to help treatment courts avoid placing premature demands on participants and address their goals in a manageable and effective sequence.

V. Substance Use, Mental Health, and Trauma Treatment and Recovery Management
Treatment courts serve high-need persons with serious and persistent substance use, mental health, and/or trauma disorders. Achieving suc­cessful outcomes for these individuals requires treatment courts to deliver services that are desirable and acceptable to participants and ad­equate to meet their validly assessed treatment needs. This includes:

• Collaborative, person-centered treatment
• Psychiatric medication and medication for addiction treatment (MAT)

Recovery management interventions should be core components of the treatment court regimen and delivered when participants are motivated for and prepared to benefit from the services.

VI. Complementary Services and Recovery Capital
Complementary services are strengths-based and help participants to develop the person­al, familial, social, cultural, financial, and other recovery capital needed to help them sustain indefinite recovery and enhance their overall quality of life.

Treatment courts should routinely assess participants’ recovery capital and deliver desired complementary services to enhance their long-term adaptive functioning and life satisfaction. Importantly, complementary services also include health-risk prevention measures that are proven to reduce overdose and death rates, transmission of com­municable infections, and other serious health risks.

Treatment courts should not interfere with participant access to statutorily authorized and evidence-based health-risk prevention mea­sures, which may include safer-sex education and training on and distribution of condoms and other safer-sex products, naloxone overdose-re­versal kits, fentanyl and xylazine test strips, and unused syringes.

VIII. Multidisciplinary Team
A dedicated multidisciplinary team of professionals brings together the diverse expertise, resources, and legal authority required to improve outcomes for high-risk and high-need participants. Team members coordinate their roles and responsibilities to achieve mutually agreed upon goals, practice within the bounds of their expertise and ethical obligations, share pertinent and appropriate information, and avoid crossing boundaries and interfering with the work of other professionals. Reliable and sustained backing from governing leadership and community stakeholders ensures that team members can sustain their commitments to the program and meet participants’ and the community’s needs.

X. Program Monitoring, Evaluation, and Improvement
The treatment court continually monitors its adherence to best practices, evaluates its outcomes, and implements and assesses needed modifications to improve its practices, outcomes, and sociocultural equity. A competently trained and objective evaluator employs scientifically valid methods to reach causal conclusions about the effects of the program on participant outcomes.

VII: Drug and Alcohol Testing
Standard VII will provide new content related to trauma-responsive testing and illicit substances. This standard will also include new and updated research and address frequently asked questions from the field.

IX: Census and Caseloads
Standard IX will have a revised title in the second edition and provide new content related to evidence-based practices in community supervision and case management. This standard will also include new and updated research and address frequently asked questions from the field.

Who belongs in treatment court? Defining the right population

Former New Hampshire Superior Court Chief Justice Tina Nadeau walks us through the key takeaways from Standard I: Target Population and addresses some of the common barriers treatment courts face during its implementation.

The conversation touches on determining who is high-risk/high-need, managing proximal and distal goals, understanding motivation for change, and building resource capacity to ensure that these individuals’ needs are met.

When Justice Heals: A personal story of addiction, recovery, and moments that transform lives

In honor of National Recovery Month, we are pleased to offer a special episode of the “Standards of Justice” podcast featuring a conversation with treatment court alumni, certified peer recovery support specialist, and National Treatment Court Alumni Association board member Deena Davis.

Deena bravely shares her story and offers invaluable insight into:

• what it’s like to sit across from the treatment court team for the first time feeling scared and ashamed,
• examples from her time in treatment court that reveal the why behind participant behavior, and
• her transition from participant to graduate to treatment court team member including an incident during staffing that was both devastating and the impetus for meaningful change.

All Rise has developed a series of free online courses to help you better understand each standard. The courses are self-paced and available via the All Rise E-Learning Center.

This presentation was given at RISE24 by the principal author of the second edition of the standards, Dr. Doug Marlowe.

In 2013 and 2015, All Rise, then NADCP, released the first edition of the Adult Drug Court Best Practice Standards in two volumes. The combined landmark document was the product of more than six years of exhaustive work by diverse experts who reviewed scientific research on best practices in treatment courts, other correctional rehabilitation programs, and substance use, mental health, and trauma treatment, and distilled that vast literature into measurable and achievable best practice recommendations.

Within two years of publication, 80% of U.S. states and territories responding to a national survey reported that they had adopted the standards for purposes of credentialing, funding, and/or training new and existing drug courts in their jurisdiction.

Several updates were made in 2018, but it became clear that the standards would need more significant revision to remain at the forefront of evidence-based best practices.

In December, 2020, All Rise convened a panel of researchers and subject matter experts—facilitated by All Rise Director of Standards Meghan Wheeler—to review each standard for necessary updates. In the following two years, the core group of contributors to this second edition; Doug Marlowe, Meghan Wheeler, John Gallagher, Carol Venditto, Terrence Walton, and Aaron Arnold, have gone above and beyond to make this publication a reality.

Dr. Douglas Marlowe, All Rise Senior Scientific Consultant, who authored the original standards, has dedicated countless hours to meticulously reviewing, critiquing, revising, and authoring new content for this second edition. His unwavering passion and diligence went into each word to ensure that the standards reflect the latest research in our field.