The CDDA legislation provides an opportunity for the Juvenile Rehabilitation Administration (JRA), in conjunction with the Division of Alcohol and Substance Abuse (DASA) and local juvenile courts, to strengthen existing chemical dependency programs for youth involved with the juvenile justice system. This will be accomplished by incorporating into existing programs additional elements of treatment that research has demonstrated to be effective in reducing substance use, and through the enhancement of linkages with community based services in order to provide a comprehensive continuum of care. Effectiveness of these treatment programs can be assessed using changes in variables which research has demonstrated to be critical in the development and maintenance of adolescent substance use problems (e.g. school performance and emotional distress). The CDDA program also provides an opportunity to evaluate the process, and any difficulties that may arise in implementation of the CDDA legislation. Furthermore, the CDDA program provides the opportunity to evaluate the short term (6 month) and long term (18 month) effectiveness of these new programs in reducing substance use and recidivism in juvenile justice involved youth.

A. Process Evaluation

Prior to performing an outcome evaluation of chemical dependency treatment programs for CDDA youth, a process evaluation will be performed. Interviews with individuals from JRA, local courts, and the DASA provider network involved with the CDDA program will be conducted by University of Washington researchers to document implementation of CDDA legislation. This evaluation will be completed by July 1998.

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B. CDDA Outcome Evaluation

To determine whether the CDDA programs are successful in decreasing substance use and recidivism, evaluations of the frequency and intensity of substance use and criminal activity of CDDA adolescents should be compared to those of appropriate comparison groups at several time-points:

• at baseline, the date of the court-ordered CDDA disposition
• upon discharge from the initial treatment placement (e.g., detention based treatment, inpatient treatment); this evaluation will provide data on the decrease in substance use achieved during the initial treatment and act as a baseline measure of substance use and general functioning for the continuing care component of CDDA treatment
• at 6,12, and 18 months following the date of the court-ordered CDDA disposition

Comparison groups will consist of those youth eligible for the CDDA program who do not participate in CDDA, and youth in the various treatment programs who have had involvement with the juvenile justice system but are currently without CDDA sanctions and supports. Youth from the CDDA program and comparison groups will be followed for the entire 18 month period, whether they complete treatment or not.

The specific outcome measures which will be employed in the evaluation of CDDA programs are the variables outlined in this report which have been demonstrated to be important to the successful rehabilitation of chemically dependent youth. Data regarding substance use and criminal activity should be corroborated at each evaluation through the use of urine drugs screens, criminal histories, and, when possible, by interviews with parents, probation officers and others involved in the treatment of the adolescent.

The outcome evaluation will address the extent to which CDDA sanctioned and supervised chemical dependency treatment results in:

• reduced criminal convictions
• reduced number of violations of the terms of community supervision
• increases in completion of any restitution to victims ordered by the court
• reduced substance use
• produces improvements in other areas of functioning (e.g., in school and family)

The number of arrests incurred over the follow-up periods will not be used as a measure of criminal recidivism in evaluation of the CDDA programs. Arrest data are difficult and costly to reliably obtain because there is no statewide database for arrests. Therefore, until there is a statewide database for arrests, arrests will not be used in determining effectiveness of chemical dependency treatment programs for CDDA youth.

The outcome evaluation of the CDDA legislation will also provide an opportunity to determine what characteristics of JRA clients are associated with successful outcomes in specific types of chemical dependency treatment programs. The evaluation will also document the nature and sequence of continuing care for youthful offenders and how continuing care is related to chemical dependency treatment outcomes.

The first data regarding outcomes will be available in 1999.

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C. Corroboration of Substance Use and Recidivism

One of the primary outcome measures for the CDDA program will be changes in substance abuse and recidivism. Much of the information regarding substance use and illegal activity will be collected directly from adolescent self-reports. There have been no rigorous studies, to date, regarding the veracity of adolescent self-reports. Some data suggest than adolescents are truthful, yet other studies find conflicting evidence between information provided by self-report and information provided by corroborating sources (Winters, 1995; Meyers, 1995). Therefore, in the CDDA project it is strongly recommended that information regarding an adolescent's substance use and criminal activity be gathered from additional sources such as reports from parents, probation officers and others involved with the adolescent's treatment as well as results from random urine drug screens and criminal histories. While urine tests are good for detecting the presence of drugs, they do not provide any information concerning frequency or duration of drug use. With the exception of marijuana, which can be detected for almost a month, urine drug screens can only detect drugs which have been used in the last 3-4 days.

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D. Data Sources

The collection and analysis of the data for the outcome evaluation of the CDDA program will be complex. Multiple sources of data will be used. The sources of data may include at the minimum:

• For Recidivism:
  • JUVIS, which is managed by the Office of the Administrator for the Courts, including information on the youth's criminal adjudications and diversions within Washington State
  • OBTS, the Department of Corrections' database provides information on adult felony convictions within Washington State
• For Demographics, Substance Use, and Other Problem Areas:
  • TARGET, DASA's management information system which includes information such as referral sources, living situation, employment/income, mental health, arrests/illegal activity, measures of substance use, and substance use diagnosis
  • Court administered Risk Assessment Instrument, which may serve as the screening instrument for CDDA if uniformly implemented by local courts
  • Comprehensive Assessment
    • Main assessment tool of alcohol and drug use and other problem areas (e.g. CASI, PEI, or ADAD)
    • DSM-IV based instrument for clinical diagnosis of chemical dependence (e.g. K-SADS)

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E. Data Collection Techniques

A Time-Line Follow-Back (TLFB) technique will be utilized at baseline and at each follow-up to obtain a continuous record of alcohol, marijuana, and other drug use (e.g., percent of days alcohol used, percent of days of heavy drinking), and time spent in controlled environments such as treatment settings and prison. Recall varies from person to person and decreases with time, therefore, we will obtain 'best estimates' of substance use over the six month follow-up periods. The TLFB is one of the most widely used outcome measures in alcohol and drug studies (Babor, 1994). The TLFB will be administered at baseline, and at the 6, 12, and 18 month follow-ups.

The primary substance abuse outcome measures will be days of use in the preceding month and the percent of days of drug use from the TLFB for the previous six months. We will also evaluate changes in the intensity of drug use (amount of a substance used during each period of use). These measures will reflect drug use during periods in which adolescents are not in controlled environments, such as incarceration, where access to drugs is limited. Validity of self-reports of drug use will be evaluated through comparisons with urine toxicology results taken by the probation department during the study period and parental reports of the adolescent's substance use.

Improvement in other important areas of functioning will be assessed using the same comprehensive instrument administered at baseline. Objective and subjective data from the adolescent and parent(s) will be used to determine if improvements have occurred in the areas of family, school, and peer relationships as well as mental health.

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F. Statistical Issues

In order to provide a statistically sound and meaningful evaluation of program efficacy it is strongly recommended that the CDDA program contract with a few treatment programs that serve a relatively large number of adolescents rather than having numerous programs serving relatively few individuals. This procedure will provide large enough sample sizes that any statistically significant differences in efficacy that may exist between the continuum of care provided for CDDA youth and standard chemical dependency treatment provided for the comparison groups will be revealed in data analyses. By utilizing fewer treatment programs as well as appropriate comparison groups, one can be more confident in concluding that any outcome differences are truly an effect of the program intervention and not some other factor.

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