Collaborations between drug courts and service providers: Characteristics and challenges

Journal of Criminal Justice 32 (2004) 253 – 263

Collaborations between drug courts and service providers: Characteristics and challenges Suzanne L. Wenzela,*, Susan F. Turnerb, M. Susan Ridgelyc a

RAND Health and Drug Policy Research Center, 1700 Main Street, P. O. Box 2138, Santa Monica, CA 90407-2138, USA b RAND Public Safety and Justice, Santa Monica, CA, USA c RAND Health, Santa Monica, CA, USA

Abstract Addressing the multiple treatment needs of drug-involved offenders can enhance outcomes including sobriety and recidivism. Meeting drug court offenders’ needs requires collaborative linkages between courts and providers of treatment and other services; however, there has been limited research on linkages. Using semi-structured interview data collected from administrators of fourteen drug courts and providers of services to offenders in those drug courts, this study described collaborative linkages and the challenges involved in fostering them. Although results suggest a moderate to strong level of linkage as perceived by both drug court administrators and service providers, services other than substance abuse treatment were sparsely provided through the drug courts. Limitations in funding, management information systems, and staffing were perceived as barriers to linkage. Results offer directions for enhancing linkages between drug courts and service providers and should be of value in improving quality of drug court treatment and offender outcomes. D 2004 Elsevier Ltd. All rights reserved.

Introduction Individuals with substance use disorders have service needs that extend beyond treatment for their drug problems. These needs often include mental and physical health, housing and family assistance, job training and placement assistance, and living skills (Belenko, 2001; Lamb, Greenlick, & McCarty, 1998; McLellan et al., 1998). Addressing the multi-faceted needs of individuals with substance use disorders can enhance treatment retention and outcomes including sobriety and recidivism (Friedman, Alexander, & D’Aunno, 1999; Friedmann, Lemon, Stein, Etheridge, & D’Aunno, 2001; McLellan et al., 1994, 1998; Widman et al., 1997). * Corresponding author. Tel.: +1-310-393-0411x6415; fax: +1-310-451-7004. E-mail address: [email protected] (S.L. Wenzel).

Substance use disorder among criminal offenders is notable (National Institute of Justice, 1993; Office of National Drug Control Policy, 1999), and druginvolved offenders also have multiple needs that, if left unaddressed, may interfere with successful treatment (Belenko, 2001). Drug-involved offenders, however, have historically had minimal access to substance abuse treatment and other health and social services (Hammett, Gaiter, & Crawford, 1998). Drug courts, authorized under Title V of the Violent Crime Control and Law Enforcement Act of 1994, represent one of the latest, most popular, and rapidly growing approaches to addressing the needs of drug-involved offenders (American University, 2001; Belenko, 2001). As of June 2001, 697 drug courts had become operational in the states, the District of Columbia, Guam, Puerto Rico, and two federal districts, with another 427 planned (Office of Justice Programs, 2001).

0047-2352/$ – see front matter D 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.jcrimjus.2004.02.005

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A fundamental principle of the drug court approach is that offenders must receive drug abuse treatment services plus coordinated and comprehensive programs of other rehabilitation services (Office of Justice Programs, 1999). The Drug Courts Program Office (2000) was established in 1995 to facilitate ‘‘. . .best practices in the development, implementation, evaluation, and institutionalization of drug courts.’’ This office developed, in collaboration with drug court experts and practitioners, ten key components that were to serve as guides for the development and operation of drug courts (Drug Courts Program Office, 1997), and two of these components pertained to addressing the multi-faceted needs of drug-involved offenders: (1) drug courts are to provide access to a continuum of alcohol, drug, and other related treatment and rehabilitation services; and (2) forging partnerships among drug courts, public agencies, and community-based organizations generates local support and enhances drug court program effectiveness. Success in meeting drug court offenders’ multiple needs was also highlighted by the General Accounting Office (1995) as requiring collaborative relationships with a variety of service organizations. A recent study recommended the construction of more formalized and effective links between drug courts and local service delivery systems (Peyton & Gossweiler, 2001). Given that the notion of collaborative relationships or linkages between drug courts and service providers was identified by key stakeholders as fundamental to drug court success, it was necessary that research shed further light on the nature of these linkages. Despite their stated importance, however, few studies examined linkages, particularly from the perspectives of both drug court and provider staff. Gaining perspectives of both stakeholders is important; their perspectives should be assumed to be similar. Potential barriers and facilitators to collaborative linkages between drug courts and service providers have not yet been addressed, although it is reasonable to think that factors such as limited resources (e.g., financial, staffing) and mutual sensitivity to the concerns and operations of drug court programs and provider organizations could influence linkages between drug courts and service providers. If the drug court field understood collaborative linkages and their barriers and facilitators in greater depth, this information could prove useful to improving drug court practice, and thus, quality of drug court programs and improved offender outcomes. It is important to note that while drug courts generally appeared promising in their impact on offender outcomes, studies were not consistent in demonstrating effectiveness (Belenko, 2001; Johnson, Hubbard, & Latessa, 2000). Effectiveness may be attributed, in part, to the extent to which a substance

problem is addressed by the drug courts program as a complex condition requiring much more than basic substance abuse treatment services and a status review hearing before the judge to gauge progress (Johnson et al., 2000). Drug courts continue to enjoy the support of federal funding through the U.S. Department of Justice, Office of Drug Courts Programs. Careful research to ultimately enhance the quality of drug court treatment and outcomes for offenders will facilitate better investment of federal dollars. Using semi-structured interview data collected from drug court program administrators and providers of services to drug court offenders, this study addressed a significant gap in the drug court literature by describing the characteristics of linkages between drug courts and providers and the challenges involved in fostering linkages. Achieving a better understanding of linkages, as well as possible impediments and facilitators, can further the goal of enhancing the links between drug courts and providers that have been so widely advocated. The following research questions were addressed in this study: (1) What kinds of agencies are providing services to offenders in the context of drug court? (2) What is the extent of linkage between drug courts and service providers? (3) Are there differences between administrators and service providers in perceptions of collaborative linkages and barriers to linkages?

Methods Participants and procedures Fourteen drug court programs participated in this study. These fourteen programs received 1995/1996 implementation grant funding from the Drug Courts Program Office (1997) and participated in an evaluation conducted by RAND (Turner et al., 2001) as a condition of their implementation grant funding. The Drug Courts Program Office provides funding for planning, implementation, and enhancement of local drug courts that operate with a specially designed court calendar or docket. While the sites were not randomly selected, they were regionally diverse and were likely to be representative of other drug courts that had met the criteria for federal Drug Courts Program Office funding, one of the primary federal sources of funding for drug courts (Cooper, 1997). Descriptive characteristics are provided in Table 1. The fourteen sites represented jurisdictions in the Southern, Mid-Atlantic, Northeastern, Western, Northwestern, Plains, and Midwest regions of the U.S. and one U.S. Territory. The cities in which the courts were located varied in population size. Adults were the target group in most of the programs, and the predominant program model

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Table 1 Characteristics of participating drug court programs Site

Region/city population (rounded)

Target group

Program model

Admissions last fiscal year

A

Southern/416,000

Adults

127

B C D E F G H I J

Southern/243,000 Northeastern/2,465,000 Midwest/2,896,000 Midwest/27,000 Plains/390,000 Western/255,000 Mid-Atlantic/95,000 Western/407,000 City in U.S. Territory/ 422,000 Western/92,000 Northwestern 196,000 Southern/303,000 Southern/78,000

Adult Adult Juvenile Adult Adult Young adult Adult Adult Adult

Pre-plea Post-plea post-adjudication Post-plea Post-plea Post-plea Post-plea Post-plea Post-plea probation Post-plea Post-plea Pre-plea Post-plea probation Post-plea Pre-plea Pre-plea Pre-plea Post-plea

K L M N

Adult Adult Juvenile Adult

169 393 55 42 130 74 88 258 * 51 44 187 199

* This site was unable to provide accurate past fiscal year admissions estimates.

was post-plea. Number of previous admissions to the drug courts for the previous fiscal year varied from 44 to 393 offenders. Drug court administrators responded to questions about their programs’ linkages with providers during one-hour, semi-structured telephone interviews with trained RAND interviewers. The organizational affiliation of the majority (ten) of the drug court administrators was with the drug court; their official job titles specifically designated them as administrators, directors, or managers of their drug court programs. Of the remaining four, one was director of substance abuse programs, one was director of the day reporting program for the jurisdiction, and two were directors or officers for the probation department. One of the drug court program administrators performed the additional role of deputy chief probation officer. None of the drug court administrators interviewed were judges. The study plan called for interviewing four different kinds of service providers, if available, for each of the fourteen drug court programs. Providers were to represent each of four different service categories: substance abuse treatment, mental health care, primary (medical) care, and other social services such as vocational training or domestic violence services. Eighteen provider agencies serving drug court offenders participated in the study. Providers were sampled in the following way. During semi-structured telephone interviews with the drug court administrators, they were asked to answer questions about linkages with respect to the substance abuse treatment provider that served the largest number of offenders in their drug court program during the past fiscal year,

the mental health care provider who did so, the primary (medical) care provider who did so, and the most common provider (in terms of number of offenders served) of some other service. These other service providers included vocational/employment, educational, housing support, and domestic violence. The administrator was asked at the end of the interview for the name of a knowledgeable contact at each provider agency so that a one-hour, semi-structured telephone interview could be conducted with that individual. Providers serving the largest number of offenders were selected because these providers should have brought a greater diversity, and thus greater representation, of experiences to bear on their discussions of linkages with drug courts. The approach, therefore, was to select agencies that were known to already provide some level of service to offenders and with which the drug court had already established some connection. Difficulties in forging and maintaining collaborative linkages were expected even among agencies currently providing services to offenders in drug court programs.

Measures Collaborative linkages Generally, linkages imply ‘‘working together’’ (Vigdal, 1995) to meet a common goal. In the case of the drug court, the goal is to achieve sobriety and cessation of criminal activity among drug-involved offenders. Drawing from previous research, the pres-

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ent study defined a collaborative linkage in terms of eleven characteristics that can occur at differing levels of quantity and quality (Anglin et al., 1996; Baker, 1991; D’Aunno & Zuckerman, 1987; Hammett et al., 1998; Marsden, 1998; Mathias, 1998; National Association of State Alcohol and Drug Abuse Directors/ National Association of State Mental Health Program Directors, 1998; Polivka, Kennedy, & Chaudry, 1997; Ridgely, Lambert, Goodman, Chichester, & Ralph et al., 1998; Selwyn, 1996; Substance Abuse and Mental Health Services Administration, 1997; Taxman, 2002): (1) The extent to which drug courts and providers accommodate each other’s practice standards; (2) the availability and extent of case management services; (3) cross training of staff; (4) documentation of relationships (e.g., written agreements); (5) resource sharing; (6) joint assessment of clients; (7) joint planning of client service goals; (8) client referrals; (9) mutual sensitivity to concerns of the other agency or program; (10) sharing of information about clients; and (11) staff meetings. Several studies and sources guided the development of measures: Assessing Local Service Systems for Chronically Mentally Ill Persons (Morrissey, Calloway et al., 1994; Morrissey, Ridgely, Goldman, & Bartko, 1994; Ridgely & Jerrell, 1996); Florida Behavioral Health Agency Survey (Ridgely, Giard, & Shern, 1999); National Association of State Alcohol and Drug Abuse Directors (NASADAD) Survey of Alcohol and Other Drug Links to and from Primary Care Services, and National Association of State Mental Health Program Directors (NASMHPD) Survey of Mental Health Links to and from Primary Care Services (NASADAD/NASMHPD, 1998); Treatment Process Study Counselor and Administrator Surveys (Hser, 1993). Even these surveys were limited, however, in their appropriateness for the current study’s objectives and specific drug court context. The majority of items in the interview protocols were therefore based not only on the above materials, but also on the study team’s collective expertise in the areas of criminal justice, drug courts, and inter-agency collaboration. Assessment of each of the eleven linkages is discussed below. Drug court administrators and providers answered identical or similar questions about each linkage. Recall periods for all questions were framed in terms of the last full fiscal year. Accommodation of practice standards was based on a single item asked of administrators and providers: ‘‘To what extent do the [drug court’s/provider’s] practice standards take into account or accommodate the practice standards of the [service provider/drug court]?’’ This question was followed with a probe: ‘‘For example, if the [drug court/provider] has a ‘controlled use’ orientation towards drugs rather than an abstinence orientation, to

what extent would your program accommodate those standards?’’ Responses were provided on a five-point scale ranging from ‘‘always’’ to ‘‘never.’’ Case management questions were asked only of drug court administrators about case managers in their drug court programs. All drug courts employed at least one case manager. Responses to eight items about the portion of offenders for whom case managers performed eight kinds of activities were provided on a five-point scale ranging from ‘‘every offender’’ to ‘‘no offenders.’’ Items included, for example, ‘‘serve as offenders’ primary point of contact,’’ ‘‘follow-up on offenders after they have graduated from the program,’’ ‘‘follow-up on offenders after they have left the program without graduating.’’ All programs had provided cross-training; therefore, the focus was on the extent of this characteristic. The cross-training linkage was based on two ‘‘yes/ no’’ items asked of drug court administrators and providers: whether there had been more than one training session, and whether there were plans to provide additional training in the future. More than one previous training session and plans for additional sessions indicated a greater extent of this linkage. Documentation of relationships was based on administrator and provider responses to three yes/no questions: ‘‘Has the [drug court’s/provider’s] service agreement with [provider/drug court] been explicitly verbalized and discussed by both parties?’’ ‘‘Has the agreement describing the service relationship with [drug court/provider] been written down in detail?’’ ‘‘Is the agreement with [drug court/provider] to provide services to offenders in the drug court legally binding and contractual?’’ Affirmative responses indicated a stronger linkage. Resource sharing was indicated by administrators and providers using a five-point scale (‘‘always’’ to ‘‘never’’) indicating the frequency that each of four resources was shared: funds, staff, facility space, and equipment. Joint assessment was measured on a five-point scale ranging from ‘‘every offender’’ to ‘‘no offenders.’’ Administrators and providers indicated the portion of drug court offenders for which the court and provider shared assessment responsibilities. Joint planning used the same scale to understand the extent to which the drug court and provider jointly plan clients’ treatment and service goals. Referrals focused on the portion of offenders referred and ranged from ‘‘every offender’’ to ‘‘no offender’’ on a five-point scale. Sensitivity to concerns was based on a single question asked of administrators and providers on a five-point scale ranging from ‘‘always’’ to ‘‘never’’: ‘‘Are [providers/drug courts] generally sensitive to the concerns and operations of your program?’’

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Sharing information addressed the extent to which drug courts and providers shared information about offenders in the drug court program: ‘‘For what portion of offenders does [drug court/provider] share the following kinds of information with [provider/ drug court]?’’ Respondents used a five-point scale (‘‘every offender’’ to ‘‘no offenders’’) to address the sharing of seven kinds of information, including, for example, basic demographic characteristics, mental health needs and problems, and physical (medical) health needs or problems. Administrators and providers responded to questions about staff meetings using a five-point scale ranging from ‘‘every day’’ to ‘‘once a year or never.’’ The questions addressed ‘‘How often have drug court and provider staff made work-related or professional contacts of any kind (in phone, written, or in-person)?’’ and ‘‘How often have there been in-person or telephone meetings between drug court administrators and higher level or administrative staff of provider agencies?’’ Greater frequency of each of these indicated a stronger linkage in this area. An index was constructed for each of the eleven linkage characteristics, separately for the drug court administrator and provider surveys. (Case management questions were asked only of administrators and thus an index for this characteristic could not be created for providers.) Each of the indices was standardized to a possible range of between 0 and 100 to facilitate comparison across the eleven characteristics: 0 indicated the extreme negative such as very poor or low linkage, or extreme disagreement with an item that expressed a linkage characteristic; 100 represented very good, strong or high linkage, or extreme agreement with an item that expressed a linkage characteristic; 50 represented the midpoint or ‘‘neutral’’ point. For the administrator and provider surveys separately, a linkage index was calculated to summarize overall ‘‘strength’’ of linkages. The overall linkage scores represented the mean of the individual linkage index scores. As for the individual indices, a higher score represented greater linkage. Case management was not included in computing the overall linkage score because the provider questionnaire did not include questions on linkages to case management. Distributions of all linkage indices were skewed, thus medians and results of non-parametric tests were used. Barriers to linkages For administrators, linkage questions about case management, cross-training, joint planning and assessment, referrals, sharing client information, and staff meetings were followed with questions about barriers to those linkages. Providers also answered

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these questions except that barriers to case management were excluded. Items presented to administrators and providers for consideration as potential obstacles to each linkage were offender confidentiality concerns, communication problems, staffing shortages, eligibility requirements, limitations in data (MIS) systems, lack of interest, funding limitations, and lack of trust. Potential obstacles to case management additionally included lack of facility space, inadequate compensation of case managers, high turnover of case managers, shortage of program resources to meet offender needs, and non-compliant offenders. As an example, following questions on cross training (i.e., whether there had been more than one training session, and whether there were plans to provide additional training in the future), administrators and providers were asked to use a four-point scale (strongly disagree to strongly agree) to consider how much they agreed or disagreed that each factor ranging from confidentiality concerns to lack of trust made it difficult to provide training or education to provider/ drug court staff. An index was constructed for each set of questions tapping barriers to case management, crosstraining, joint planning and assessment, referrals, sharing client information, and staff meetings. Each barrier index ranged from 0 to 100, where 100 represented extreme agreement with the barrier item and 0 complete disagreement. All barrier indices were rounded to the nearest integer. Separately for the administrator and provider surveys, an overall barriers index was created by calculating the mean of the individual barriers scores. Case management was not included in computing the overall barrier score because the provider questionnaire did not include questions on barriers to case management. Similar to linkages, distributions of all barriers indices were skewed and thus medians and results of non-parametric tests were used.

Results Providers to drug court offenders The first finding of note lies in the difference between the number of service providers that administrators reported for their drug court and the number of service providers interviewed. As previously explained, administrators were asked to answer questions about their drug court’s linkages with major providers (i.e., largest in terms of number of offenders served during past fiscal year) of substance abuse, mental health, primary (medical) care, and other services to offenders. As shown in Table 2, all fourteen administrators were able to answer ques-

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Table 2 Service providers for which each of fourteen drug courts A through N could discuss linkages Site

Substance abuse

Mental health

Primary care

Other services

A B C D E F G H I J K L M N

X X X X X X X X X X X X X X

X X X X X X X X

X X X

X X X

X X

X X X X

X X

X

X X

known. In one instance, an administrator stated that the drug court program instructs offenders to visit the county hospital for help with medical problems. There was no evidence of assistance provided to the offender in achieving this visit, follow-up to ensure that he or she made the visit, or discussion between drug court staff and the care provider. Table 3 also indicates that of the eighteen providers interviewed, thirteen provided substance abuse treatment. Nine of these thirteen additionally provided mental health services of some kind. Of these nine, five additionally provided either primary care or other service. Five other agencies out of the original eighteen provided mental health, primary care, or other services but not substance abuse treatment. Linkages – administrator and provider perspectives

X

X

tions about linkages with a substance abuse treatment provider, eleven answered questions about a mental health provider, six answered questions about linkages with a primary care provider, and ten answered questions about some other service provider. As indicated in Table 3, however, when interviewers requested a name and contact information for these providers at the conclusion of their interviews with administrators, a total of only nineteen of these providers could be identified by the drug court administrators. (Eighteen of these providers were available to be interviewed.) Each drug court administrator could identify at least one agency that provided one or more of the four types of services, typically substance abuse treatment, to drug court offenders. For nine drug courts, a single agency provided more than one type of service. Eight drug courts named only one agency providing either a single service or more than one service. Of these eight agencies, four provided only substance abuse treatment to drug court offenders. No drug court administrator could name providers for all four types of services. There were two reasons why fewer provider agencies were identified by the drug court administrators than for which the administrators answered linkage questions. First, a single agency often provided more than one service to the drug court offenders. Second, although contact information for providers was requested, information provided by the administrator was not always specific enough to permit the study team to contact the provider agency. In these cases, a location (such as a university or hospital) where services (such as job training or medical care) were provided could be named by the administrator, but the identity of a specific individual with whom a study interviewer could speak about linkages with drug court was not

The second set of findings draws upon the eleven linkage characteristics and their comparisons between drug court administrators and providers. Linkage index scores for both administrators and providers are displayed in Table 4. Although means and standard deviations are reported for the readers’ examination, skewness of distributions called for reliance Table 3 Service providers identified by drug court administrators Site

Substance abuse

Mental health

Primary care

Other services

A B C D E F G H I J K L M N

1* 1# 1 1 1 1 1 1 1 1 1 1 1 1

1

1

2#

12 1 12

12

3# 1

1 1 1 2# 1

1 2 1 2 2# 2

1

* The numerals 1, 2, and 3 are used to denote distinct provider agencies within each drug court program. For example, the administrator of drug court ‘‘A’’ reported one agency providing three service types. Court ‘‘C’’ reported two unique provider agencies, one providing substance abuse treatment, mental health care, and primary care, and the other providing mental health and primary care. # indicates that a drug court administrator identified a provider but that an interview could not be completed due to insufficient or inaccurate contact information from the administrator that could not be clarified (social service for sites A, C, and J), or because the provider refused to participate (substance abuse treatment for site B, mental health care for site K).

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Table 4 Linkage index scores – perspectives of administrators and providers Index

Accommodation of practice standards Case management Cross-training Documentation of relationships Resource sharing Joint assessment Joint planning Referrals * Sensitivity to concerns Sharing client information Staff meetings Overall linkage (ten items) * *

Administrator survey (N = 14) Mean

S.D.

Med.

66.1

31.9

63.4 80.8 65.1 45.9 64.1 68.3 68.0 82.1 83.4 64.5 68.6

16.8 38.4 30.2 30.0 37.9 31.2 23.5 28.5 17.5 16.9 16.1

Provider survey (N = 18)

Min

Max

Mean

S.D.

Med.

Min

Max

75.0

0

100

80.8

28.7

88.0

0

100

67.5 100.0 67.0 50.0 72.0 65.5 60.5 100.0 87.5 63.0 67.5

25 0 17 0 0 25 31 0 54 25 43

91 100 100 100 100 100 100 100 100 100 94

69.2 83.5 52.2 65.5 84.7 92.3 82.8 86.9 60.8 76.5

43.5 21.5 46.6 43.1 28.5 27.7 17.3 22.5 18.8 11.9

100.0 100.0 50.0 88.0 100.0 100.0 88.0 98.0 51.0 77.0

0 33 0 0 0 0 38 21 25 56

100 100 100 100 100 100 100 100 88 93

* p < .05 (Mann-Whitney U test). ** The overall linkage is the mean of all linkage types except case management. Service providers were not asked about case management. Higher numbers indicate stronger linkages.

Barriers – administrator and provider perspectives

upon the medians in understanding and reporting findings. There was a significant difference between administrators and providers in perceived strength of referrals, in that providers’ scores on referrals were higher than administrators’ scores on this dimension. As is evident from the scores across the eleven dimensions in Table 4, however, fairly high levels of linkage were perceived by both administrators and providers. Considering median scores on the eleven dimensions individually, cross-training and sensitivity to the concerns of service providers appeared to be the top or ‘‘strongest’’ linkages relative to others among the administrators, with scores of 100. Cross-training, documentation of relationships, joint planning, and referrals appeared to be the strongest linkages from the perspectives of the providers, all having scores of 100. With median scores of 50 for both administrators and providers, resource sharing appeared to be the poorest linkage.

Scores for barriers indices calculated from the administrators’ and providers’ surveys are displayed in Table 5. As for linkages, distributions of variables directed the authors to rely upon the medians in understanding and reporting findings. Judging from overall barriers scores ranging from a possible 0 to 100, administrators’ and providers’ perceptions of barriers were relatively weak in that each barrier index was below the midpoint of 50. From the perspective of both administrators and providers, barriers to sharing client information, referrals, and joint planning/assessment were greatest and staff meetings least problematic. The apparent differences among most of these barriers, however, were very small. There were no statistically significant differences between administrators and providers. In addition to examining the barrier index score, the extent of administrators’ and providers’ agree-

Table 5 Barrier index scores – perspectives of administrators and providers Index

Administrator survey

Provider survey

Mean

S.D.

Med.

Min

Max

Mean

S.D.

Med.

Min

Max

Case management Cross-training Joint planning/assessment Referrals Sharing client information Staff meetings Overall barriers (five items) *

46.5 34.7 35.9 36.4 38.9 26.4 34.4

17.1 16.5 14.2 21.5 18.3 20.0 14.4

42.0 34.5 35.5 35.5 37.0 31.0 32.0

16 10 14 0 7 0 16

69 67 57 69 71 67 65

25.5 32.6 27.8 33.4 23.2 28.5

12.8 14.9 14.3 15.6 16.0 13.5

27.0 31.0 31.0 31.0 22.0 27.0

0 4 0 0 0 1

42 67 47 67 56 53

* The overall barrier index is the mean of all barriers types except case management. Service providers were not asked about case management. Higher numbers indicate stronger barriers.

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be fostered through enhanced communication and education.

ment with each individual barrier item making up that score was examined, for each linkage. Table 6 depicts the percent of administrators and providers who agreed or strongly agreed that components represented barriers to linkages. Funding limitations received some of the strongest endorsements as a barrier by both administrators and providers. Data systems and data sharing (e.g., management information systems; MISs) and staffing shortages also emerged as problematic. Overall, concerns about maintaining offender confidentiality, problems in communicating with each other (i.e., difficulty in contacting and discussing issues with drug court or provider), and the level of concern emerging from offenders’ drug court or provider eligibility requirements were not notable relative to funding, data systems, and staffing. There was consistency in barriers across the different linkages and across administrators and providers, in that funding limitations, data systems/data sharing, and staffing shortages appeared to be the drivers of the barriers scores shown in Table 5. The eighteen providers were additionally asked, in an open-ended fashion, what they believed would strengthen or improve their relationships or collaborations with drug courts. All but one provider answered this question. More funding was mentioned by only one respondent, despite the strong endorsement of funding limitations as a significant barrier. Nine of the providers emphasized a need for greater and more frequent communication between drug courts and providers and more education of each party regarding what the other does for offenders. More communication and education of each party regarding the roles of the other is arguably a characteristic that can be facilitated through cross-training. Of the nine respondents who emphasized communication and education, four mentioned that greater respect for each others’ activities/roles or trust would

Discussion All fourteen participating drug courts could identify a substance abuse treatment provider; this was to be expected given that the minimum service provided in the context of drug treatment court was, by definition, substance abuse treatment. Other service types, including mental health services and primary care, were more sparsely provided through drug court programs. The fact that administrators could not always identify an individual in a provider agency that could be contacted for interview suggested in itself a very informal relationship between drug courts and these providers. Many of the relationships between drug courts and community-based providers appeared informal in contrast to the recommendations of the Drug Courts Program Office (1997) and General Accounting Office (1995). Additionally, a report by the Office of Justice Programs (1999) concluded that many drug courts were diversifying services to address the multi-faceted needs of offenders, were providing physical and mental health services to participants, and were expanding capabilities to support housing, employment, and other needs. The National Drug Court Treatment Survey (Peyton & Gossweiler, 2001) suggests that drug courts generally recognize that an array of services is necessary to meet client needs and thus to enhance prospects of treatment success, but that access to services other than treatment for substance abuse is lacking. The findings were consistent with this observation. Regarding the linkage characteristics that were operationalized and examined in this study, scores across the eleven linkage characteristics suggested that, from the perspectives of both administrators and

Table 6 Components of barriers indices: percent of administrators (N = 14) and providers (N = 18) who agreed or strongly agreed that components were barriers to linkages Components of barrier indices

Confidentiality Communication problems Staffing shortages Eligibility requirements Data systems/data sharing Lack of interest Funding limitations Lack of trust

Barrier indices Cross-training

Joint planning/ assessment

Referrals

Admin

Prov

Admin

Prov

Admin

7.1 14.3 28.6 17.9 32.1 7.1 39.3 14.3

0.0 5.6 13.9 2.8 8.3 11.1 33.3 5.6

21.4 14.3 25.0 17.9 51.8 7.1 39.3 14.3

22.2 11.1 27.8 13.9 33.3 5.6 50.0 5.6

28.6 28.6 28.6 25.0 32.1 7.1 42.9 14.3

Sharing client information

Staff meetings

Prov

Admin

Prov

Admin

Prov

5.6 5.6 19.4 5.6 18.1 0.0 38.9 0.0

35.7 21.4 42.9 32.1 46.4 7.1 39.3 21.4

11.1 11.1 22.2 2.8 34.7 5.6 50.0 0.0

0.0 14.3 28.6 10.7 25.0 7.1 35.7 14.3

5.6 5.6 36.1 5.6 12.5 5.6 13.9 5.6

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providers, the drug courts and provider agencies had a moderate to strong level of collaboration with each other. Resource sharing was the exception to the favorable linkage scores. The relative weakness in resource sharing could point to an inability to engage in this activity due to resource shortfalls in these areas, lack of perceived need or interest in sharing, or simply different organizational structures. The findings of moderate to strong perceptions of collaboration based on linkage scores were interesting in light of the informality that was represented by the uneven availability of mental health, primary care and other services, and by drug court administrators’ occasional difficulty in identifying providers. These findings, however, did not represent a discrepancy so much as a reflection of the study’s focus on linkages with providers that had already established at least some contact with the drug court. Administrators and providers demonstrated consistency in their perceptions of barriers to linkages. Barriers scores were low overall relative to linkage scores, yet it should be noted that even the strongest linkages as perceived by both administrators and providers (e.g., sharing client information) were accompanied by at least minimal corresponding barriers scores. This suggested a challenge to fostering linkages and possibilities for facilitating those linkages. For example, despite the low barriers scores overall, administrators’ and providers’ endorsements of several individual items making up the barriers scores were notable: limitations in management information systems (MISs), limitations in funding, and to a lesser extent, staffing. These findings were in line with recommendations emerging from other work that drug courts must have strong MISs and the staffing and funding to implement and maintain them (Peyton & Gossweiler, 2001; Wenzel, Turner, Longshore, & Ridgely, 2001). An earlier report on these fourteen drug courts revealed limited MIS capabilities, and that five of the fourteen had no MIS (Wenzel et al., 2001). Most of the drug courts in operation across the nation did not have a MIS (Peyton & Gossweiler, 2001). Adequate funding for drug courts is likely also to be an important enabler for linkages; instability and uncertainty regarding future funding may prove a disincentive to investing in linkages (Wenzel et al., 2001). Indeed, limited funding may reasonably have been a contributor to this study’s finding that mental health, primary care, and other services besides substance abuse treatment were sparsely provided. Regarding staffing, due to limited resources drug court staff are sometimes performing multiple roles (Wenzel, Turner, & Ridgely, 2002). That administrators and providers perceive these limitations as barriers to collaboration heightens the urgency regarding these resources.

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Open-ended responses of providers regarding what might strengthen collaboration with drug courts were interesting in light of the fact that cross-training was endorsed as the strongest linkage for the administrators and providers. The respondents’ views about enhancing linkages seemed not to focus on the simple obverse of the barriers components (e.g., more funding, MISs, more staff), however, but rather on enhanced communication. The findings suggest that a greater investment in linkages that are already considered strong might have benefit, and that increased funding and strong MIS capabilities (limitations in funding and MISs were highlighted as strong barriers) alone could be insufficient unless communication is facilitated in the process. Perhaps communication is facilitated by these resources, but does not necessarily follow from them. Cross-training might be conducted more regularly and comprehensively to facilitate the communication and education that seemed to be so important to respondents. Additional research might probe more extensively into the practices of crosstraining and other strong linkage characteristics to enable a more precise understanding of their nature and value. In considering findings regarding favorable linkages, a limitation in making comparisons between drug court administrator and provider reports was that a number of administrators were discussing provider agencies where a specific contact person could not be identified. That is, administrators answered questions about their linkages with some providers that the study team did not have the opportunity to interview because specific provider contacts could not be identified by administrators. Notable in light of this limitation was that administrators’ perceptions of linkages with providers was so favorable overall. Linkages might have appeared less positive from the perspective of providers had the team been able to interview those providers who could not be identified by the drug court administrators. A similar limitation was present for barriers, in that administrators might have been referring to some providers that ultimately could not be interviewed due to inadequate contact information. Linkages with providers that did not already have at least some contact with drug courts were not emphasized, thus future studies might expand an investigation of linkages to include potential providers of services to drug court offenders in the surrounding communities. The current study represented a partial picture of what system-level collaboration on behalf of offenders might look like, and might present a ‘‘better case’’ scenario. Also regarding providers, this study’s scope did not permit a concentration on the complexities of defining a provider, nor did it permit a focus on gathering information about the larger organizations in which these agencies might have been

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enmeshed. In future studies, more conclusive results regarding linkages would also be facilitated by a larger sample of drug courts. This study made a principal contribution in operationalizing collaborative linkages, and in describing barriers to linkages, between critical players in the treatment and rehabilitation of drug-involved offenders. It highlighted that, despite the need for strong collaborative relationships between drug courts and community-based providers that was expressed by multiple stakeholders, further work is needed to achieve this goal. The information resulting from this study should be of value ultimately in enhancing linkages and thus in improving quality of drug court treatment and offender outcomes.

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