Henggeler, S., Halliday-Boykins, C., Cunningham, P., Randall, J., Shapiro, S., & Chapman, J. (2006). Juvenile drug court: Enhancing outcomes by integrating evidence-based treatments. Journal of Consulting and Clinical Psychology, 74(1), 42-54.
- The study’s objective was to examine the marginal impacts of three layered treatments—drug court hearings, substance abuse therapy, and contingency management counseling—on criminal justice outcomes and positive drug screens among youth in Charleston, South Carolina, diagnosed with substance abuse or dependence.
- The authors randomly assigned eligible youth to one of three treatment groups—drug court, drug court with multisystemic therapy, or drug court with multisystemic therapy enhanced by contingency management—or to a control group that received typical family court services.
- The study found no statistically significant differences between the groups on measures of recidivism after one year. However, the study found that participants in the treatment groups reported committing fewer delinquent acts than those in the control groups. Effects on drug screens were mixed.
- The quality of causal evidence presented in this report is high for recidivism outcomes because they are based on a well-implemented randomized controlled trial but moderate for self-reported delinquency and drug screen outcomes because they had high attrition and the authors demonstrated that the groups being compared had similar baseline characteristics.
Features of the Intervention
The study was a randomized controlled trial designed to test three layers of drug court treatments. The authors randomly assigned eligible participants to one of three treatment groups or a control group, which received typical family court services.
- The Charleston County Department of Juvenile Justice referred the drug court-only group (DC) to a drug court and they met with a therapist. Before each appearance in drug court, youth submitted a urine sample for drug testing and each youth, caregiver, and therapist assessed drug use, compliance with rules at home, school behavior, and participation in treatment. Positive drug test results could result in sanctions (from community service requirements to detention). Sustained negative drug test results could result in rewards (from fast food meals to event tickets) and reduced frequency of court appearances (from an initial requirement of appearing weekly to biweekly or monthly appearances).
- The multisystemic therapy (DC-MST) group was referred to a drug court (with all the implications described above) and met with a therapist who provided multisystemic therapy, a home-based manualized treatment that emphasized cognitive-behavioral therapy techniques. MST therapists met with families for 2 to 15 hours per week, depending on the family’s specific needs, and had caseloads of only four or five families to ensure each youth benefited from intensive MST services.
- The multisystemic therapy enhanced by contingency management (CD-MST-CM) group received the same treatment as the CD-MST group except that the therapists serving this group received an additional day of training on integrating contingency management concepts, skills, and exercises into the MST program. CM focused on addressing substance use behaviors, in addition to substance abuse (which is the focus of MST). CM components in the study included a voucher system to reward clean drug tests, analysis of drug use behavior to inform self-management planning, and providing protocols for self-management.
Features of the Study
From January 2000 to June 2003, 2,123 potential participants in the Charleston County Department of Juvenile Justice were screened for alcohol or drug abuse and other inclusion criteria. Of the 165 youth deemed eligible for the study, 161 agreed to participate and were randomly assigned to one of three treatment groups or a control group. The authors used an iterative approach to first identify statistically significant outcomes by different combinations of treatment level (DC, DC-MST, and DC-MST-CM) and time period (pre-treatment, 4 months following enrollment, and 12 months following enrollment) before assessing whether each component of the full treatment had an effect on key outcomes.
- Recidivism. The study found no differences between any of the groups on measures of recidivism one year following enrollment.
- Self-reported delinquent behavior. Youth in all three drug court groups (DC, DC-MST, and DC-MST-CM) reported committing fewer status offenses relative to youth in the family court group. Youth in the DC and DC-MST-CM groups also reported committing fewer crimes against people than youth in the family court group.
- Drug screens. Youth in the DC-MST-CM group failed fewer drug screens than youth in the DC group in the first 4 months after enrollment and from the 4th to 12th months after enrollment. Youth in the DC-MST groups failed fewer drug screens than youth in the DC group from the 4th to 12th months after enrollment.
Considerations for Interpreting the Findings
Youth in the DC-MST and DC-MST-CM groups were expected to have greater contact with the service providers than youth in the DC and family court groups. The authors reported that youth in the DC-MST and DC-MST-CM groups received an average of 66 and 57 hours, respectively, of direct or indirect treatment over the four-month period. However, due to poor record-keeping systems for youth in the DC and family court groups, the authors were unable to determine how much contact they had with service providers.
The quality of causal evidence for the recidivism outcomes is high because it was based on a well-implemented randomized controlled trial. However, the self-reported delinquency and drug screen outcomes had high sample attrition, making them ineligible to receive a high causal evidence rating. Because the authors demonstrated that the groups being analyzed had similar characteristics before beginning the treatments, these outcomes receive a moderate causal evidence rating.
Causal Evidence Rating
The quality of causal evidence presented in this report is high for recidivism outcomes because they were based on a well-implemented randomized controlled trial. This means we are confident that any estimated effects on recidivism would be attributable to the treatment being examined, and not to other factors. However, the study found no statistically significant effects of the treatments on recidivism. The quality of causal evidence presented in this report is moderate for self-reported delinquency and drug screen outcomes because they had high attrition and the authors demonstrated that the groups being compared had similar characteristics before beginning the treatments. This means we are somewhat confident that the estimated effects are attributable to the treatments being tested, but other factors might also have contributed.