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Promising Program Seal

Drug Court: Baltimore City

Blueprints Program Rating: Promising

A coalition of public, private and non-profit agencies that provide intensive supervision, substance abuse treatment and comprehensive judicial monitoring to offenders whose crimes are non-violent and related to substance abuse to facilitate their integration back into a healthy community.

  • Adult Crime
  • Delinquency and Criminal Behavior

    Program Type

    • Adult Crime Prevention
    • Drug Court/Teen Court
    • Drug Prevention/Treatment

    Program Setting

    • Adult Corrections
    • Mental Health/Treatment Center
    • Transitional Between Contexts

    Continuum of Intervention

    • Indicated Prevention (Early Symptoms of Problem)

    A coalition of public, private and non-profit agencies that provide intensive supervision, substance abuse treatment and comprehensive judicial monitoring to offenders whose crimes are non-violent and related to substance abuse to facilitate their integration back into a healthy community.

      Population Demographics

      This particular Drug Court was implemented and evaluated in Baltimore, Maryland, with a sample of drug offenders who were predominantly Black and of a mean age of 35 (Gottfredson & Exum, 2002).

      Age

      • Adult

      Gender

      • Male and Female

      Race/Ethnicity

      • All Race/Ethnicity

      Subgroup Details

      The majority of participants in Gottfredson and Exum (2002), and subsequent experiments involving the same sample, were Black males. However, the Drug Court is designed for use with both genders and individuals of all ethnic backgrounds.

      • Individual
      Risk Factors
      • Individual: Favorable attitudes towards drug use, Substance use

      The Baltimore City Drug Treatment Court is a program for district and circuit court cases that are supervised by the Baltimore City Division of Parole and Probation. District Court cases involve misdemeanor charges, while the Circuit Court deals with felony cases, and these two tracks of entry into Drug Court both occur post-conviction. In other words, clients generally enter the program as a condition of probation. During the evaluation, the Drug Court also received clients on a pre-conviction (diversion) track. In such cases, clients typically enter the program on the condition that their charges would be dropped after successful completion.

      To be eligible to participate in the Baltimore Drug Court, individuals must be at least 18 years old, must live in Baltimore City, and must not have any violent offenses (prior or current). Potential clients are informed of the availability of the Drug Court by public defenders. The state's attorney completes record checks to ensure eligibility and meets with the public defender to discuss which individuals would be best served by Drug Court. As a part of this decision making process, individuals complete the Psychopathy Checklist and the Addiction Severity Index, both administered by staff in the Drug Court Assessment Unit. Information regarding drug history, medical history, employment status, and other aspects of the individual's family and social relationships are also collected. Individuals who are recommended for participation, as well as those involved in the decision making process, then appear before the Drug Court judge to discuss the case. The Drug Court judge makes the final decision as to whether or not the individual will be placed in the program.

      Program participation involves intensive supervision combined with drug testing, drug treatment, and judicial monitoring over the course of two to three years.

      The Baltimore City Drug Treatment Court is a program for district and circuit court cases that are supervised by the Baltimore City Division of Parole and Probation. District Court cases involve misdemeanor charges, while the Circuit Court deals with felony cases, and these two tracks of entry into Drug Court both occur post-conviction. In other words, clients generally enter the program as a condition of probation. During the evaluation, the Drug Court also received clients on a pre-conviction (diversion) track. In such cases, clients typically enter the program on the condition that their charges would be dropped after successful completion.

      To be eligible to participate in the Baltimore Drug Court, individuals must be at least 18 years old, must live in Baltimore City, and must not have any violent offenses (prior or current). Potential clients are informed of the availability of the Drug Court by public defenders. The state's attorney completes record checks to ensure eligibility and meets with the public defender to discuss which individuals would be best served by Drug Court. As a part of this decision making process, individuals complete the Psychopathy Checklist and the Addiction Severity Index, both administered by staff in the Drug Court Assessment Unit. Information regarding drug history, medical history, employment status, and other aspects of the individual's family and social relationships are also collected. Individuals who are recommended for participation, as well as those involved in the decision making process, then appear before the Drug Court judge to discuss the case. The Drug Court judge makes the final decision as to whether or not the individual will be placed in the program.

      Program participation involves intensive supervision combined with drug testing, drug treatment, and judicial monitoring over the course of about two years. To facilitate intensive supervision, participants must allow probation officers to conduct two home visits per month and meet with them outside the home at least three times per month. As clients progress through treatment, these visits are required less often. Clients also submit verification of employment status once per month.

      The frequency of drug testing varies based on which phase of the Drug Court program the client is in. In other words, and similar to probation officer visits, drug testing is required less often as clients progress through the program. During Phase I, clients submit two urine samples per week for three months; in Phase II they submit one sample per week for three months; and in Phase III, once-monthly tests are required for a period of 6 months. After this point, if the client remains in Drug Court, drug tests are conducted only at random until program completion. Most clients finish the program between two and three years after initiation. Prior to establishing the standard schedule, during the early implementation of the program, the testing schedule was somewhat more individualized and less structured, and as described in Gottfredson et al. (2003), this covered a portion of the program evaluation period.

      In addition to supervision and testing, clients receive substance abuse treatment services from one of eight possible treatment providers. Three of these treatment programs provide intensive outpatient counseling, two provide methadone maintenance, two provide inpatient care, and one provides transitional housing. Decisions regarding these programs are made based on the type of treatment required, the treatment center's availability, and the treatment center's proximity to the client's residence.

      Finally, the judicial status hearings allow a Drug Court judge to monitor a client's progress through the program. These hearings are held once every two weeks and allow the judge to also sanction individual clients based on noncompliance or problematic/lack of progress through treatment. Sanctions typically involve increased contacts with probation officers, increased status hearings, or increased drug testing. Severe violations can result in probation revocation.

      Drug Court participation increases the number of judicial status hearings attended, which reduces the variety of drugs one uses as well as the variety of crimes one commits. The latter is impacted due to an increase in one's perceptions of procedural justice. Additionally, Drug Court participation increases self-reported social controls (direct and indirect social controls) through increases in the duration of substance abuse treatment. Increased social control then reduces multiple drug use frequency.

      • Social Control

      From February 1997 to August 1998, referrals from district court, circuit court, and the Alternative Sentencing Unit were randomly assigned to the Drug Court treatment condition or a control condition which consisted of typical intensive supervision probation. A total of 235 participants were randomized, with data collection taking place at baseline, after one and two years of implementation, at three years (posttest), and at 12-year follow-up. Data included information on demographics, prior offenses, and recidivism as assessed through self-reports and official records of rearrest, reconviction, and reincarceration.

      Those assigned to Drug Court were significantly less likely than controls to be rearrested in interim, at both one and two years after program entry (Gottfredson & Exum, 2002; Gottfredson et al., 2003). At posttest, however, effects on rearrests were reduced to marginal significance (using alpha of .05 and two-tailed tests) or, in the case of the number of incarcerations, favored the control group (Gottfredson et al., 2006). By the end of the 12-year follow-up, treatment group participants again displayed significantly fewer rearrests and fewer new charges than control group participants (Kearley, 2017). They were also significantly less likely to be charged with a violent or sex crime after one year (Gottfredson & Exum, 2002) and with drug offenses after both two and three years (Gottfredson et al., 2003, 2006). Drug Court participation also significantly delayed time until rearrest, particularly for drug crimes, relative to controls (Banks & Gottfredson, 2004).

      Significant program effects for those randomized to Drug Court, relative to controls, on:

      • Likelihood of rearrest, in interim (Gottfredson & Exum, 2002; Gottfredson et al., 2003)
      • Number of new arrests and new charges, at 12-year follow-up (Kearley, 2017)

      An analysis of potential mediators was conducted with self-report data (Gottfredson, Kearley, Najaka, & Rocha, 2007) from individual interviews at 3-year follow-up (n=157). This analysis revealed that Drug Court did not significantly increase participants’ access to drug testing or drug treatment, relative to what was available to control participants.

      Effects sizes were not reported.

      Generalizability of effects is limited to residents of Baltimore, Maryland, sentenced through both district and circuit courts. Results of analysis of data through the first year of the program suggest greater effectiveness with those sentenced through the circuit court, who were charged with felony offenses.

      Additionally, it is difficult to generalize effects of this Drug Court to others, as Drug Courts differ in their design and operation from location to location. While this Drug Court is reportedly "typical" of all Drug Courts, the use of referrals to substance abuse treatment agencies in the community problematizes generalizability. Along these lines, participants do not all receive the same substance abuse treatment and without examining differences in such treatment, one cannot conclude that it is the Drug Court alone which is responsible for the evident effects on recidivism.

      • Fewer offenders with a baseline felony charge assigned to treatment (Gottfredson & Exum, 2002)
      • Beneficial impacts in interim and at 12-year follow-up, but no posttest main effects remained significant (Gottfredson et al., 2006)
      • Iatrogenic effects of treatment at posttest on number of incarcerations, which may have been explainable by the district court judge's behavior in response to treatment non-compliance (Gottfredson et al., 2006)

      Competing Interest Statement: A Blueprints Advisory Board member contributed to this program evaluation and co-authored several of the publications we reviewed in considering its evidence for certification. This board member recused herself from the decision process and was not present for the discussion of the program's evidence.

      • Blueprints: Promising
      • Crime Solutions: Promising

      Banks, D., & Gottfredson, D. C. (2003). The effects of drug treatment and supervision on time to rearrest among drug treatment court participants. Journal of Drug Issues, 33, 385-412.

      Banks, D., & Gottfredson, D. C. (2004). Participation in drug treatment court and time to rearrest. Justice Quarterly, 21(3), 637-658.

      Gottfredson, D. C., & Exum, M. L. (2002). The Baltimore city drug treatment court: One-year results from a randomized study. Journal of Research in Crime and Delinquency, 39(3), 337-356.

      Gottfredson, D. C., Kearley, B., Najaka, S. S., & Rocha, C. M. (2005). The Baltimore City drug treatment court: 3-year self-report outcome study. Evaluation Review, 29(1), 42-64.

      Gottfredson, D. C., Kearley, B., Najaka, S. S., & Rocha, C. M. (2007). How drug treatment courts work: An analysis of mediators. Journal of Research in Crime and Delinquency, 44(1), 3-35.

      Gottfredson, D. C., Najaka, S. S., & Kearley, B. (2003). Effectiveness of drug treatment courts: Evidence from a randomized trial. Criminology & Public Policy, 2(2), 171-196.

      Gottfredson, D. C., Najaka, S. S., Kearley, B., & Rocha, C. M. (2006). Long-term effects of participation in the Baltimore City drug treatment court: Results from an experimental study. Journal of Experimental Criminology, 2, 67-98.

      Gray Barton, Director
      Office of Problem-Solving Courts
      Administrative Office of the Courts
      2001 E/F Commerce Park Drive
      Annapolis, MD 21401
      Phone: 410-260-3617
      richard.barton@mdcourts.gov

      Evaluation Methodology

      Design: Referrals made to the Baltimore City Drug Treatment Court from February 1997 through August 1998 were accepted into the study. These referrals came from district court, circuit court, and the Alternative Sentencing Unit. A total of 235 adult, low-level drug offenders with no history of violent offenses were recruited through this procedure.

      Assignment: Offenders were randomly assigned to the Drug Court treatment condition or a control condition, which consisted of typical intensive supervision probation, by district and circuit court judges. Participants from circuit court were assigned to each condition at a ratio of 1:1 (one treatment assignment to every one control assignment), while participants from district court were assigned at a ratio of 2:1 (treatment to control). Judges occasionally deviated from the random allocation procedure on a case-by-case basis, with 9% of treatment and 7% of control participants ultimately assigned to the unintended condition. The treatment condition included 139 offenders while the control condition included 96 offenders.

      Assessments/Attrition: Data collection took place at baseline and each year thereafter until most had completed or were dismissed from the program, approximately 3 years later (posttest). An additional long-term follow-up assessment occurred 12 years later, or 15 years post-baseline. Analyses using official records allowed for the inclusion of all 235 participants at the first interim (one-year) and posttest (three-year). Two participants (one treatment and one control) were excluded from survival analyses at the second interim (two-year) due to being incarcerated the entire period. Self-report data at posttest were only collected from 157 (67%) participants. By the 12-year follow-up, 21% of the sample had died, leaving official records data for 79% of participants.

      Sample: Of the 235 individuals recruited, 54 came from the district court's Division of Parole and Probation (32 treatment, 22 control), while 72 came from the district court's Alternative Sentencing Unit (52 treatment, 20 control). Nearly half (n=109) were referred from circuit court, and were thus charged with felonies, while the remainder sentenced in the district courts were charged with misdemeanors. All were adults, with an average age of 35 years; 74% were male and 89% were African American. Participants, on average, had about 12 prior arrests and 5 prior convictions. The most current offense was a drug offense in 71% of cases.

      Measures: Data included information on demographics, prior offenses, and recidivism as assessed through official records of rearrest, reconviction, and reincarceration in interim, at posttest, and at 12-year follow-up. Additional measures assessed at intake included educational and employment status and drug use history.

      Many participants were also interviewed at posttest to provide self-report measures of criminal activity, drug use, mental and physical health, family and social relationships, education, and employment. Interview protocols were adopted from the Addiction Severity Index, the High-Intensity Drug Trafficking Area Life Events Survey, and the Brief Symptom Inventory.

      Analysis: Methods of assessing intervention effects differed considerably across articles, from using ANCOVA to two-stage regression models testing instrumental variables to cox survival models and negative binomial regression. Overall, analyses typically controlled for originating court (district or circuit) because random assignment was conducted differently in each court, though the method of adjustment varied across articles. Analyses did not generally adjust for baseline offending characteristics or criminal history, except for the assessment of instrumental variables impacting posttest recidivism (Gottfredson et al., 2006) and the long-term follow-up assessment of recidivism (Kearney, 2017).

      Intent-to-Treat: Judges occasionally disrupted random assignment and many treatment group members were dropped from the program, but all data were still used for most analyses and tests assessed all participants within the groups to which they were statistically assigned.

      Outcomes

      Implementation Fidelity: A number of participants randomly assigned to treatment or control were not actually dealt with in the correct court (9% of treatment cases were handled in standard court and 7% of control cases were transferred to the drug court) because of judicial discretion. At posttest, 31% of drug court cases had graduated from the program and 45% had been terminated for non-compliance, suggesting a low rate of success in drug treatment. However, the treatment group did average more time spent in various aspects of drug treatment than the control group.

      Baseline Equivalence: There were no significant differences between treatment and control groups at baseline on age, gender, percent African American, number of prior arrests, number of prior convictions, type of current offense, and percentage of initial arrests which included violent, property, drug, sex, violation of probation, or "other" charges. The number sentenced in circuit court (for a felony) versus district court (for misdemeanors) did differ significantly, however, with a higher proportion of the treatment group sentenced for misdemeanors in district court than the control group. To attempt to adjust for this imbalance, the analysis weighted control and treatment participants differently based on their ratio of assignment from each type of court (control participants were weighted 1.5 and treatment participants were weighted 0.75).

      Differential Attrition: For self-report measures, the attrition rate of 33% did not differ between groups. However, those interviewed at posttest (n=157) significantly differed from those not interviewed on recidivism, such that those retained had a higher number of re-arrests than those who were lost to follow-up. There was no difference in mortality rates between the treatment and control groups at the 12-year follow-up, but males and blacks made up the vast majority of those who died, though there was no test for whether demographics differed significantly between attritors and those remaining in the study.

      Interim
      : Drug Court participants were significantly less likely than controls to be rearrested in the first year of the study (Gottfredson & Exum, 2002). Among those who were rearrested, the number of rearrests and the number of charges were both significantly lower for treatment group participants. Finally, for those charged with a new offense, treatment group participants were significantly less likely than controls to be charged with a violent or sex crime. These effects are found primarily among those whose cases originated in the circuit court -- meaning they were felony cases.

      Two years after program entry (Gottfredson, Najaka, & Kearley, 2003; Banks & Gottfredson, 2004), Drug Court participants were significantly less likely to be rearrested, had significantly fewer average number of new arrests and new charges, and when charged, were significantly less likely than controls to be charged with a drug offense. However, treatment participants were significantly more likely to be sentenced to incarceration (within the circuit court only) as part of the disposition of their referring offense. They were significantly less likely, however, to be sentenced to incarceration after disposition. There were no differences in the percentage of reconvictions or the average number of new convictions between groups.

      Posttest: By the end of the three-year intervention period, treatment and control participants did not differ on time until rearrest or the likelihood of rearrest (Gottfredson, Najaka, Kearley, & Rocha, 2006). However, Drug Court participants who were rearrested had significantly fewer new arrests, new charges, and charges for drug-related crimes than controls. Iatrogenic effects were observed for number of incarcerations, which the authors argue were a result of the district court judge using short incarceration stays as a response to noncompliance with the intervention.

      On posttest self-reported outcomes (Gottfredson, Kearley, Najaka, & Rocha, 2005), there were no program effects on arrests in the past 12 months. There were also no effects on crime variety, drug variety, days of alcohol, cocaine or heroin use in the past 12 months, drug or alcohol addiction severity, employment, receipt of income from public assistance or from illegal activities, medical status, family and social relationships, or mental health severity. However, Drug Court participants committed crimes that were significantly less serious than the crimes committed by controls.

      Long-Term (12-Year) Follow-Up: Twelve years after most of the sample completed treatment (Kearley, 2017), treatment group participants had significantly fewer arrests than the control group, both in total unique arrests and total cumulative arrest charges. Treatment group participants also had significantly fewer convictions across all charge categories when compared to the control group participants.

      After 15 years, 21% of the baseline sample had died. Most deaths were related to drugs/alcohol or were the result of a related disease/infection; however, there were no differences in mortality or drug-related deaths between conditions.