Adult DUI/DWITreatment CourtProgramsOffice of ProblemSolving Courts

Maryland’s Guidelines for Planning and ImplementingAdult DUI/DWITreatment CourtPrograms

MARYLAND’S GUIDELINES FOR PLANNING AND IMPLEMENTINGDUI/DWI Treatment Court ProgramsOffice of Problem-Solving Courts2011-D Commerce Park DriveAnnapolis, MD 21401Phone: 410.260.3615Fax: 410.260.3620

Table of ContentsPrefaceIntroduction1. Planning A Drug Treatment Court1.Judicial Leadership . .42.Planning Committee . . .43.Assessing the Problem. . . .54.Planning Committee Expansion. . .62. Developing Program Operational Procedures1.Mission, Goals and Objectives . . . 72.Target Population . . . . 83.Program Eligibility. . . 94.Program Structure. . . .105.Screening and Assessment .106.Entry Process . . . .117.Incentives and Sanctions . . .118.Judicial Supervision . .129.Community Supervision . . .1310. Substance Abuse Treatment Services 1311. Ancillary Service . . . .1512. Case Management Services. . . .1513. Alcohol and Other Drug Testing. . .1614. Graduation/Termination Criteria. . . .1715. Information System to Monitor Participant Progress and Program Operation. . .1816. Ongoing Program Review and Evaluation .183. Addressing Policy Issues1.Assuring Due Process . . .202.Confidentiality . . .203.Relapse . . .204.Alumni Activities. . . .215.Cultural Competence. . . .216.Media and Public Relations . .227.Oversight Committees. . . .228.Funding the Program. . . . . .234. Resources. . . . .241

PrefaceDUI/DWI treatment courts are built upon a unique partnership between the criminal justice system and the drug andalcohol treatment community. A single DUI/DWI treatment court judge, through his or her authority and personalinvolvement, structures treatment intervention. DUI/DWI treatment courts are dependent upon the creation of a nonadversarial courtroom atmosphere where a single judge and dedicated team of court officers and staff work together towardthe common goal of breaking the cycle of alcohol abuse and criminal behavior.2

IntroductionMaryland’s Drug Treatment Court MovementMaryland’s drug treatment court movement started in the early 1990’s as a response to the surge of drug-relatedcases, which overwhelmed dockets and caused enormous trial delays. Maryland’s first drug treatment court began inMarch 1994, in the District Court for Baltimore City. The Circuit Court began their program shortly thereafter, inOctober of that same year.The Drug Treatment Courts provide a dynamic alternative to addressing drug and drug-related cases. Currently,there is extensive drug treatment court development and expansion underway in the State of Maryland. ThreeDUI/DWI Courts currently exist in Anne Arundel, Howard and Harford Counties.It has been agreed upon that the typical multiple DUI offender shares some common characteristics with the typicaldrug offender participating in a drug treatment court program. Each has a serious substance abuse problem; eachrequires treatment, a support system, and the ability to come to terms with their problem before real change can occur.The Office of Problem-Solving Courts established in 2006 pursuant to an Administrative Order of Chief JudgeRobert M. Bell. The Office of Problem-Solving Courts leads the State’s effort to operate and maintain drug treatmentcourt programs for the State of Maryland. Oversight committee members include: Circuit Court and District Courtjudges, legislators, representatives from the Department of Health and Mental Hygiene, the Department of JuvenileServices, the Department of Public Safety and Correctional Services, State’s Attorney’s Offices, the Office of the PublicDefender’s, the Governor’s Office of Crime Control and Prevention, the Maryland Association of Public HealthOfficers, providers of addiction treatment services, and community leaders.3

It is critical that the representatives attending the meetings have decision-making capacity for their organizations.3. Assessing the ProblemThe answer to the question of whether a DUI/DWI court is neededin a particular jurisdiction depends upon a determination ofwhether current practices and services for handling alcoholaddicted defendants are effective.Many jurisdictions have approached the planning task by selecting a sample of relevant cases handled in the past.Symptoms/Red FlagsSymptoms/red flags that may suggest the need to improve the court’s handling of DUI/DWI offenders and potentially the utilityof a DUI/DWI court program can include: Relatively high percentage of alcohol and alcohol related offenses filedRelatively high rates of recidivism and probation violationsRelatively high rates of addiction to alcohol and other drugs reflected in the defendantpopulationRelatively low rates of substance abuse treatment retention for this populationConsistent overcrowding in local jailThe impact of alcohol-abusing defendants may initially be reflected in the traffic docket but generally spills over to the entirecaseload of the court, in particular, domestic, juvenile, and dependency matters.Identifying the problemsSymptoms of ineffective practices regarding the court’s handling and disposition of alcohol-abusing defendants aregenerally reflected in (1) evidence that a significant percentage of arrestees are alcohol users; and (2) relatively high recidivism (e.g.,re-arrest) rates and probation violation among these defendants. If data is not readily available to ascertain the degree to which thesefactors are present in your jurisdiction, a sample of cases disposed of over the past two to three years may need to be taken.Generally probation staff can be very helpful in compiling this sample.Information needed to determine current practices Defendant demographics: age, gender, race, ethnicity, education, public assistance status, employment statusAlcohol and substance abuse historyPrior record and sentencesPost sentence services provided to defendantRecidivism among the current substance-abusing populationCriminal justice resources available/needed5

Identify treatment availability What treatment services are available in the community? Where are they located? What are there eligibility requirements?What is the waiting time for a defendant to enter treatment? What is the nature of treatment being provided? Whatmechanisms are used to determine whether a defendant has stopped using alcohol following his/her disposition?What mechanisms ensure the coordination and the delivery of services as well as accountability of both the serviceproviders and the defendants?What other support services are available including: treatment services, mental health services, public health services,housing, vocational, educational, family, and other support services?Where are the gaps in treatment resources? What other ancillary resources do alcohol-abusing individuals need to recover?4. Planning Committee ExpansionOnce the need for a DUI/DWI court has been established, it isoften helpful to add additional representatives to the planningcommittee who can enhance the perspectives and resources of theinitial group.They members may be drawn from: Business communityEducational communityPublic health communityFaith communityDay care providersVocational and job training/placement agencies Housing providers Medical/dental providers Program evaluators Citizen groups Community based entitiesWhile not all of these representatives may be actively involved in the planning process, they can serve as a valuable resourcefrom which to draw upon, as needed, to develop a full range of program services. These representatives will also be able to serve asadvocates for the program as planning and implementation occur.6


Program ObjectivesObjectives are specific outcomes or action steps to achieve each goal. Exactly what you will attempt to accomplish forwhom and in what time period – set of measurable situations, which when achieved will satisfy need. Program objectives shouldbe: Clearly stated, realistic results that achieve the program goalsQuantifiable with measurable outcomesResponding to participant, stakeholder, and community needs2.Target PopulationIdentify the population that will be best served by the DUI/DWItreatment court. This will help define the scope and focus of theprogram.Initial considerations in developing the target population may include: Defendant characteristicsRisk level of offenderExtent of substance abuse problemCriminal and traffic history Community resourcesTreatment availabilityDocketing limitationsSupervision and drug and alcohol testing capacity PoliciesCommunity impactPolitical realitiesGeographical obstaclesCultural competenceLanguage barriersThe nature of alcohol and drug use, arrest patterns, treatment and other resources, as well as justice system handling ofsubstance-involved offenders is continually changing in most communities. What was a given situation at the time of programplanning may well change by the time the program has been operating for six months. Redefining the program’s target populationwill be an ongoing aspect of an operational DUI/DWI treatment court.8

3. Program EligibilityMost likely the program can’t serve the entire target population.Therefore, eligibility criteria need to be developed to focus on thedefendant population that the program can serve.Specific eligibility requirements must be designed to ensure consistency in defendant selection and reduce net widening oromission of appropriate candidates.Generally, the eligible population will be more limited than the targeted population. This will be due, primarily, to a lack ofavailable resources, such as: fiscal, programmatic, transportation, staff, etc.The concept of eligibility should be broken down into four components: offense qualifiers/disqualifiers and offenderqualifiers/disqualifiers.Eligibility ConsiderationsOffense Qualifiers/Disqualifiers Nature of crime – Drunk driving offenseSeverity of crime – Personal injury involvementType of crime – Alcohol relatedType of drug – AlcoholOffense Qualifiers/Disqualifiers Legal Open warrants Pending cases Parole/probation statusPrior record Violent offenses Weapon offenses Arrests vs. convictions Severity of offense—number of prior DUI/DWI offenses; BAC .15 Length of time since offensePersonal Demographics – age, residency, gender Severity of alcohol use Types of drugs abused Prior treatment Mental health issuesOther Considerations Funding sources often require that programs exclude offenders with certain types of criminal histories. Exclusion of certain offenses that impact victims.9

4. Program Structure (pre-plea, postplea, etc.)The type of program structure establishes the method of entry intothe DUI/DWI court and subsequent program operations.Determining the program model will be based on several factors including: The nature of the eligible population (e.g., first offenders or persons with significant prior DUI/DWI convictions)Prosecution policiesExisting programs regarding alcohol-related offensesGenerally, the program structure will have little or no effect on the actual service provided to each participant, which isdetermined, primarily, by the initial and ongoing clinical assessments of the individuals’ alcohol abuse needs and performance in theprogram.Below are the most common models; however, a combination of them and others are also employed based upon theindividual needs of the jurisdiction. Diversion plea—the defendant pleads guilty as a requirement of participation in the program; however, the plea iswithdrawn and the case is dismissed upon completion of the program.Deferred sentencing—a guilty plea is accepted and sentencing is deferred pending program participation. Upon successfulcompletion of the program an appropriate probationary sentence is imposed or the case is dismissed.Post-conviction probation—the defendant is placed on probation with the successful completion of the program as acondition of probation.5. Screening and AssessmentIntervention and screening of potential DUI/DWI treatment courtparticipants should occur as soon as possible after arrest to expeditetheir involvement in treatment and capitalize on motivation forbehavior change associated with the crisis of the recent arrest.Screening ProcessThe screening process determines whether individuals are appropriate and eligible for the program based upon the targetpopulation criteria. Potential DUI/DWI court participants screening should address both legal and the clinical components.Legal: Criminal history, offense type, and severity The State’s Attorney’s Office traditionally handles this function; however, the Public Defender’s Office, pre-trial services, lawenforcement, the DUI/DWI treatment court coordinator or other court personnel can also conduct this assessment.Clinical: Brief assessment of substance abuse, social history, and willingness to participate DUI/DWI court case manager, pre-trial services, probation, or the treatment provider can conduct this assessment.10

Assessment Process:The purpose of the assessment is to properly match the DUI/DWI treatment court candidate with the type of treatmentservices needed to address problems while ensuring that the community is reasonably protected from the risk of drunk drivingbehavior.All candidates are assessed either before entry into the program or at treatment entry to develop individualized treatmentplans to establish clinical appropriateness for the treatment provider. A clinically trained and qualified counselor, social worker,psychologist, or psychiatrist should perform this assessment.Assessments should culminate in a placement that is least intensive/restrictive first and then intensify as clinically indicated.Ongoing assessments, pursuant to accepted clinical practices, are necessary to monitor progress, to change the treatment plan ifnecessary, and to identify relapse.Cultural proficiency is an important element of the assessment process and should be considered when engaging thedefendant and motivate the individual to want to participate in the program and recognize the advantages it can provide in terms ofrecovery and life situation. Program staff involved in the assessment process should bear in mind that a significant number ofdefendants may distrust the justice system and not feel comfortable initially in becoming involved in a program as intensive andintrusive as the drug treatment court.6. Entry ProcessDetailed procedures to identify and process defendants into theDUI/DWItreatment court program are necessary to expedite thetransfer of cases to the program while ensuring that legal safeguardsand rights of the individual are preserved.The DUI/DWI court team should answer the following questions: How will cases flow through the DUI/DWI treatment court system?What time frames will apply?What court events will apply?Will there be a need to create new court events? (e.g., initial program entry hearing, review hearings, etc.)How will terminations be handled?What mechanisms will be needed to promote early case screening and disposition?7. Incentives and SanctionsBoth positive and negative reinforcements help to develop theDUI/DWI treatment court participant’s sense of accountability andto encourage compliance with the program.Incentives:Criminal justice agencies have traditionally punished negative behavior, and have seldom used incentives to promotepositive behavior. The DUI/DWI treatment courts’ use of incentives encourages positive behavior by the participant by using astrength-based approach. The program also provides positive reinforcement to those who have rarely received praise. DUI/DWItreatment courts should identify and incorporate the strengths and past successes of the participants and build upon them. Theprogram should constantly look for new ways to encourage participants to succeed.11

Incentives might include: Applause and/or verbal accoladesEarning points toward a rewardModifying treatment requirementsIncreasing the time between judicial status conferencesDecreasing supervisionEarly termination from the programWaiving of program feesTransportation VouchersSanctions:Sanctions are immediate consequences for negative or inappropriate behavior. They demonstrate that participants will beheld accountable for relapse and other programmatic and behavioral infractions. They are typically imposed during status hearings.Sanctions should be graduated and become more restrictive as the severity and frequency of infractions increase.Planning sanctions in advance enables the team to have a rational response to participants who test the limits andboundaries of program rules or who are ambivalent toward treatment. They should be revisited after the program is operational toassess their effectiveness.Immediacy of consequences is a critical factor in the effectiveness of both incentives and sanctions. Behavior is mosteffectively addressed when directly attributed to a specific action.Sanctions may include: Increased urinalysis, breathallyzer, supervision, or treatmentEssay writingCommunity serviceImposition of a curfewCourtroom/jury box detentionElectronic monitoring or house arrestShock incarcerationTermination from the program8. Judicial SupervisionThe focus and direction of a DUI/DWI treatment court program areprovided through the effective leadership of a single DUI/DWItreatment court judge.Pre-hearing Staffings (Optional): Staffings enable the DUI/DWI treatment court team to discuss each case so that thejudge will have a foundation for the recommendations made and as relevant background as possible to meaningfullyaddress each participant at the court hearing. Note these staffings are optional and confidentiality policy should beestablished.12

DUI/DWI Treatment Court Hearings: These hearings are conducted in open court to monitor defendants’participation and progress, and to alter case management plans as needed. Conferences generally occur every 2 to 6 weeksdepending on the level of the defendant’s participation, progress and addiction. Generally, they are more frequent at theinitial stages of program participation. If necessary, the DUI/DWI treatment court coordinator will summons thedefendant to appear before the judge for an accelerated hearing.9. Community SupervisionDUI/DWI treatment court supervising agents provide communitysupervision for all participants and monitor their compliance withconditions imposed by the DUI/DWI court judge throughout thelength of the program.Community supervision agents apply different levels of supervision designed to help the participants combat their addictionand prevent relapse, as well as to obey the law and comply with program conditions. They maintain close contact with eachparticipant through frequent office and home visits.Agents will also interact with the treatment team, family members, employers, and social services agencies to implement theteam approach to each participant’s recovery. They also routinely coordinate, refer, monitor and help manage daily activities toensure compliance and promote well-being. They often act as the liaison between local agencies and the DUI/DWI treatment courtprogram, striving to incorporate the community into each participant’s treatment plan.Probation agents often provide community supervision for DUI/DWI treatment courts, but this function can be served byother sources, such as treatment or the DUI/DWI court coordinator.10. Substance Abuse TreatmentServicesTreatment is an integral part of the DUI/DWI treatment courtprogram and its role is to provide counseling and techniques of selfexamination that promote continued abstinence from alcohol anddrugs.The program will be most effective if a seamless continuum of services is available and responsive to the needs of eachparticipant. Most treatment programs attempt to accomplish this by varying structure, duration, and intensity of services. Acontinuum of service allows for placement of individuals recovering from substance abuse in a setting that is equipped to meetindividual needs.Ranges of treatment modalities to treat alcohol and substance abuse addicts are described below: Early Intervention Services – treats patients who may be in the early stages of alcohol or drug use. Services include:assessment, treatment planning, case management, group or individual counseling, and family services.Detoxification Services – monitors the decreasing amount of alcohol and other drugs in the body, manages withdrawalsymptoms, and motivates the individual to participate in an appropriate treatment program for alcohol or other drugdependence.13

Outpatient detoxification services – includes physical examination, medical evaluation, assessment, treatment planning,administering and monitoring medication, monitoring vital signs, discharge or transfer planning, and referral services.Inpatient detoxification services include: nursing assessment at admission, physical examination, addiction assessment, treatment planning, discharge or transfer planning, monitoring of vital signs, administering of medication, family services,alcohol and drug education, motivational counseling, and referral services.Intensive Outpatient – provides structured outpatient evaluation and treatment of patients who require programmingnine or more hours weekly. Services include: assessment, treatment planning, case management services, individualcounseling at least once monthly, and leisure and recreational activities.Halfway Houses – offers a living space, plus treatment services directed toward preventing relapse, applying recoveryskills, promoting personal responsibility, and reintegration. Services include: case management, individual counseling atleast once monthly, and leisure and recreational activities.Long Term Residential Care — provides structured environment in combination with medium intensity treatment andancillary services to support and promote recovery. Services include: assessment, treatment planning, alcohol and drugeducation, individual counseling, leisure and recreation counseling, referral services, and assistance with vocational issues.Therapeutic Community – provides a highly structured environment in combination with moderate to high intensitytreatment and ancillary services to support and promote recovery, and uses the treatment community as a key therapeuticagent. Services include: medical assessment, physical examination, assessment, treatment planning, medicationmonitoring, therapeutic activities which may include, individual and group counseling, alcohol and drug education, careercounseling, nutrition education, and family services.Medically Monitored Intensive Inpatient Treatment (Intermediate Care) – provides a planned regimen of 24-hour,professionally directed evaluation, care and treatment in an inpatient setting. Services include: weekly individualcounseling, treatment planning, group counseling, alcohol and drug education, nutrition education, weekly family sessions,case management, medical evaluation, physical examination, medication monitoring, sub-acute detoxification, medicalservices, diagnostic services, and referral services.Medication-Assisted Treatment – uses pharmacological interventions such as an abuse to provide treatment, supportand recovery services to alcohol-addicted patients. Services include: medical assessment, physical examination, counseling,drug and alcohol testing, medication administration and monitoring, and referral services.AccessibilityAccommodations should be made for persons with special needs, including but not limited to: Physical disabilitiesLanguage and fluency issuesLiteracy issuesTreatment programs, ideally, are located in areas that enable access to the support services and are accessible by publictransportation, when possible. Treatment services should also be available during both day and evening hours.Cultural ProficiencyTreatment services must also be culturally proficient (e.g., have both the staff and services that acknowledge the values andperspectives of the participant’s culture). “Culture” in its broadest sense encompasses gender, race, ethnic background, age,economic status, social status, etc.14

11. Ancillary ServicesMost DUI/DWI treatment court participants have other problemsthat contribute to addiction and require variety of other services to aidin recovery.Substance abuse treatment services may be limited in their impact if these services are not provided. Therefore, localofficials will need to develop a range of support services that should be provided to participants such as: AIDS Counseling Community Support Programs Anger Management Educational Training Childcare Family Counseling Cognitive Behavior Therapy Housing Assistance Legal Assistance Self-Help Groups Life Skills Training Sexual, Emotional, Domestic Abuse Counseling Meditation or Yoga Social/Athletic Activities Money Management Vocational Training and Placement Parenting Skills Training12. Case Management ServicesThe function of case management services is to provide a centralpoint for referral to an array of ancillary services to support DUI/DWItreatment court participants in their alcohol abuse treatment.Most treatment providers limit their services to treatment. Therefore DUI/DWI treatment courts may wish to designate anindividual to serve as a case manager to oversee the treatment and other services relevant to each participant.The case manager ensures that each participant receives appropriate services that are needed and can act as a liaisonbetween the court, the participant, the other participating agencies, and service providers.15

13.Alcohol and Other Drug TestingFrequent, random and monitored testing provides currentinformation regarding participants’ progress and holds themaccountable for their actions.An effective DUI/DWI treatment court program must have the capacity to: Conduct frequent and random alcohol and other drug tests of participants Obtain test results immediately Maintain a high degree of accuracy in test resultsSubstance abuse testing within a DUI/DWI treatment court is designed to deter future usage, to identify participants whoare both maintaining abstinence or who have relapsed, and to guide treatment and sanction decisions. Research indicates that withgreater frequency of tests, drug use declines substantially and the potential for both short and long term su

the DUI/DWI court and subsequent program operations. Determining the program model will be based on several factors including: The nature of the eligible population (e.g., first offenders or persons with significant prior DUI/DWI convictions) Prosecution policies Existing programs regarding alcohol-related offenses