Panel Paper: Drug Court Clinical Screening: A Call for Quality Performance Measurement

Saturday, April 8, 2017 : 8:50 AM
Founders Hall Room 470 (George Mason University Schar School of Policy)

*Names in bold indicate Presenter

Brandy F Henry, Brandeis University
Research on drug court best practices has lagged behind the rapid proliferation of the drug court model. This growth of drug court, prior to the delineation of best practice guidelines, has led to wide variability in program design and implementation. This paper describes the drug court model and current evaluation standards, using Massachusetts as a case study. Finally, it proposes a quality measure of drug court clinical screening in order to standardize the evaluation of drug courts against current evidenced based guidelines.

Literature Review
Despite the widespread use of the drug court model, standardized quality measures for drug courts do not yet exist. However, existing best practices have been outlined. The “10 Key Components of Drug Courts” are the gold standard of structure and process guidelines for drug courts. The 10 components been endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA) and continue to be widely utilized in designing drug courts.
In order to operationalize the “Key Components” of drug court, specialized quality measures are needed to improve programs and standardize evaluations. This paper focuses on Key Component #3: early identification and placement in drug court. This component focuses on the screening process involved in identification and placement.

Case Study
Drug court programs are fairly widespread in Massachusetts and serve high risk/high need juveniles and adults. This population has been demonstrated to have the strongest positive effects from drug court participation. Massachusetts drug courts serve individuals who are post-plea and post-adjudication. After referral participants are screened for eligibility, which includes a clinical element. However, a recent evaluation found that no standardized or validated clinical screening tool is in place in any drug court within Massachusetts. The evaluation recommended that Massachusetts drug courts adopt a standardized clinical screening tool to reduce subjectivity in screening.

Proposed Tool
Using best practice standards and existing research, the following measure is proposed to be used as a tool to both improve drug court quality and standardize comparisons across programs, by improving and standardizing the clinical screening process within drug courts. The National Quality Forum format for endorsed quality measures was utilized to develop the proposed measure. This proposed measure would report the percentage of legally eligible drug court participants, aged 18 years and older who were clinically screened, by a qualified professional, using a systematic screening method, for unhealthy alcohol use, nonmedical prescription drug use, and illicit drug use, which meets criteria for a Substance Use Disorder, according to the DSM 5.

Policy Recommendations
Moving forward policies should be established to translate evidence based drug court practices into standardized and validated quality measurement tools. The proposed quality measure for clinical screening outlined in this paper could be the first such tool. Quality measures based on the other key components and relevant outcomes should also be developed and validated. Benchmarks for relevant outcomes could then be delineated. Clear standards such as these will help continue to establish the evidence base for drug court programs, and improve service quality.