A Community Based Drug Treatment Court

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• A Community Based Drug Treatment Court
• Drug Treatment Court Ottawa (DTCO)

R. Paul Welsh, MSW Executive Director Rideauwood
Addiction and Family Services, Ottawa
James Budd, HBSW Manager/Coordinator Rideauwood
Drug Treatment Court Programs
Addictions Ontario Conference June 2006
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Presentation Overview

• History of the Drug Treatment Court of Ottawa
• Getting Started What Do We Know Today (2002)
• Who would the clients be?
• What do they need?
• What should we do?
• What can we do?

• Developing The Model/Partnerships
• Developing The Proposal Quick Partnerships
• What is the Model as Planned?
• Start Up
• Hiring
• Hugely Abbreviated Start Up Time
• The Best Laid Plans....

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History of the Drug Treatment Court of Ottawa

• A phone call
• Are you interested in doing a proposal for a Drug
  Treatment Court?
• Absolutely, your Honour.
• Meeting with the Judge where we were told what
  was needed
• Abstinence Model, therapeutically and humanely
  applied in a legal (Court) context Crown, Judge,
  Defense Counsel, Probation, Treatment as a Team
• Urine screens are required
• Want to work with only 1 treatment provider as
  primary
• No funding to go to residential service
• Unsure about methadone
• Unsure about alcohol and legal drugs of addiction
• Officers of the Court No confidentiality of
  relevant info use of drugs, crime,
  potential difficulty leading to crime/relapse
• Use the best of your judgment in proposal
• Our committee will decide which organizations
  proposal well choose
• Then we refine and submit
• The budget is for your Treatment
• 30 Adult clients max and 10 Youth max

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Getting Started What Do We Know Today (2002)

• Addiction is a Health Problem with legal/crime
  symptoms
• Requires a Health/Treatment solution to address
  root causes for long term change
• Homelessness, abuse, poverty, lack of options are
  obstacles to client success
• Mental health problems, literacy and
  employability and hopelessness are, too
• Choice in Treatment is powerful motivation
• Respect and caring are empowering
• Positives are more powerful than punishments
• In abstinence goals/focus intoxication on any
  drug of less harm increases risk of relapse to
  drug of choice

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Who would the clients be?

• Long term problems (A lifetime of neglect, abuse
  and anomie since childhood) require long term
  service
• Relapse is to be expected and dealt with
  constructively, with respect and with clinical
  responses, not disciplinary or punitive responses
  if change is to last
• We want real change, not just compliance for a
  period of time then return to crime

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What do they need?

• Excellent treatment staff research says the
  clinical alliance is the most powerful factor,
  more than a model, philosophy of addiction or
  methods
• Groups are powerful
• Early focus must be on Engagement, Alliance, and
  Stabilization
• Long term view of service
• Housing and supports
• Literacy and employment skills
• Transportation and food
• Mental Health service
• Health care
• Women staff, womens group

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What do they need? Contd

• Expertise from those who specialize in population
  appropriate needs plus addiction expertise
  co-therapist with partnered services
• Relapse Prevention any time
• Power of the Court coercive initially,
  therapeutic eventually
• Following 14 years of de facto Provincial funding
  freezes, there were cuts and compromises made in
  programming (shorter duration, less individual
  counselling, lower staff clients ratios will
  not be sufficient)
• Need longer, more frequent service, with as many
  of the current gaps in safety nets addressed, and
  higher staff to client ratio

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What should we do?

• All of the above, AND ANYTHING ELSE WE CAN THAT
  OCCURS TO OUR PARTNERS AND TEAM
• Court appearances twice weekly and treatment
  three times weekly is demanding
• DTCO is not easier than jail...3 of 15 approved
  by Crown said No Thanks when fully informed of
  requirements

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What can we do?

• Ditto....WE WILL AIM HIGH AND FIGURE OUT HOW

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Developing The Model/Partnerships

• Agency met with 4 agencies known to or partnering
  with us and we brainstormed
• Credibility In The Bank after years of working
  together paid big dividends
• Best practice search
• Recruiting partners was four phone calls
• What CAN be done?
• We decided to figure out HOW TO DO WHAT WAS
  NEEDED
• Who can do what
• Fell to Natural selection
• Roughing out the treatment
• FIVE meetings, five drafts, three to four months
• Roughing out the Partner Services
• Purchase .25 FTE from each
• IN THE BUDGET

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Developing The Proposal Quick Partnerships

• Treatment
• Abstinence/Harm Reduction (moderating
  consumption) Issue
• This took a little discussion to achieve mutual
  comfort level (consciousness raising)
• What are the Court and Treatment doing with which
  drugs?
• Use of any drug of addiction is a risk for
  relapse to drugs of crime
• The Judges address this in twice weekly
  conversations, praise and admonition
• Intensity/Frequency of counseling/treatment
  sessions
• Group Counseling versus Individual Counseling
  Costs and Benefits
• Day Treatment
• Length of Treatment
• Special Needs Populations
• Victimized Women, Concurrent Disorders, First
  Nations, GLBT, Francophones, Immigrant/Refugee/New
  Canadian Communities
• Special Needs Populations versus Mainstreaming
• Homelessness and Housing Supports
• Literacy and Employment
• And Limited (750,000 to 649,000 Requested
  DOWN TO 515,000 received)

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What is the Model as Planned?

• Screening by Crown for Eligibility
• Briefing and Consent of Accused with Counsel
• BIT (Brief Interview for Treatment)
• Assessment
• Pre-court Meeting/Discussion
• Admission
• Treatment
• Two groups weekly for nine months, one group
  weekly for last three months
• Open ended access to Relapse Prevention group
• Individual counselling once weekly for three
  months, at two weeks for next three months, once
  every four weeks for next three months, as needed
  for last three months

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What is the Model as Planned? Contd

• Purchase off Service/Partnerships
• John Howard society co-therapist and access to
  housing and other services
• Criminality and Addiction, Housing and Housing
  Supports Literacy Training, Employment Support
  services
• Elizabeth Fry Society co-therapist and access to
  housing and other services
• Victimization and Abuse And Addiction, Housing
  and Housing Supports, Literacy Training,
  Employment Support services
• CMHA co-therapist for Concurrent Disorder (up to
  moderate Mental Health problems) screening and
  assessment consultation for Admission
• Somerset West Community Health Center Nurse
  Practitioner numeral one half day/weekly, Store
  Front Medical Service, technical support /
  consultation/ interpretation of urine screens,
  array of health social and mental health services

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Start Up

• The phone call
• Huge decision in the blink of an eye (Cut the
  Youth Program, cut )
• YAAAAAHHHOOOOOOOOO!!!!!!!
• Scramble Wait Scramble Wait Scramble Wait Wait
  Wait Wait Wait
• SCRAMBLE ! ! THE 35 JUMP
• The only Drug Treatment Court in Canada with
  Justice Canada Funding Agreement to a Community
  Based agency, the Easternmost DTC in Canada
  (Vancouver, Edmonton, Regina, Winnipeg, Toronto,
  Ottawa)
• Recruitment
• Planned three months, got two weeks due to no
  for ads untill cash flowed
• Increased Management complement and front line
  admin staff complement
• Increased compensation of Management Team
  involved
• Everyone won out at the same time...Part plan,
  part good luck

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Hiring

• Assigned some of our most appropriate staff half
  time into DTC to ensure what Rideauwood does best
  will be carried into DTCO
• Hired staff from higher paid jobs for .5 DTCO and
  .5 mainstream
• Reputation of job satisfaction was also
  attractive to people in larger institutional
  employment
• Two Classes Of Staff?
• Two purchase of service agreements came in same
  year at new salary scale, plus all fund raising
  revenue applied to raise all staff to equal levels

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Hugely Abbreviated Start Up Time

• Funding expected August/September 2005
• Recruitment Heads planned for September 2005
• Hiring planned for October 1 to November 10
• Training and orientation (internal) planned for
  November 20 to December 12
• Court training (Court 101) planned for December
  15
• Toronto DTC team planned to train DTC Ottawa
  court and treatment January 6
• DTCO Treatment and full Court team planned to
  train in Toronto mid January
• Training local agencies planned for mid-January
  to mid-February
• START UP planned for mid-February 2006

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The Best Laid Plans....

• Funding arrived mid-November
• Recruitment and hiring completed December 14
• Jumped into Court 101 December 15
• START UP February 28
• Start Up phase reduced from a plan of 26 weeks to
  13 weeks
• We had 11 Rideauwood staff, 2 Justices, 1 Crown
  Prosecutor, 1 Duty Counsel, 1 Probation Officer,
  the Ottawa Detention Center, Court Police
  Security, 3 Courts Administration Staff, 1 other
  Defense Counsel, 1 Legal Aid Manager, 5 partner
  agencies, 2 evaluators officer trained and up and
  running when court opened and the first accused
  was admitted February 28, 2006