Adult Treatment Court Best Practice Standards Last updated July 28, 2025

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Contents Introduction

Target Population

Roles and Responsibilities of the Judge

COMMENTARY

Multidisciplinary Team

COMMENTARY

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Substance Use, Mental Health, and Trauma Treatment and Recovery Management

Complementary Services and Recovery Capital

COMMENTARY

Community Supervision

COMMENTARY

Incentives, Sanctions, and Service Adjustments

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Drug and Alcohol Testing

COMMENTARY

Program Monitoring, Evaluation, and Improvement

COMMENTARY

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These standards are intended to be consistent with federal constitutional principles and federal law, including the Health Insurance Portability and Accountability Act (HIPAA), 42 CFR Part 2, the Americans with Disabilities Act, and other applicable laws and regulations in effect at the time of their writing. However, it is important that treatment courts consider the lawfulness of their policies and practices and ensure conformance with federal laws and court decisions, as well as any applicable state constitutions, laws, or regulations.

Introduction

The Adult Treatment Court Best Practice Standards represent over two decades of research on treatment courts, criminology, and behavioral health. The standards distill this research into actionable best practices, providing a comprehensive blueprint to enhance outcomes across all treatment court models.

As a dynamic and evolving resource, the standards are periodically updated to incorporate the latest research, address emerging issues, and add new insights.

All Rise maintains a rigorous peer review process involving treatment court practitioners, researchers, and other subject-matter experts. The commentary and references continue to be revised to be more user friendly and to support practical implementation and will be added as they become available.

All Rise is committed to ensuring that these standards are achievable and measurable. Therefore, we offer an array of companion resources, including in-depth commentary on each standard, practice guides, toolkits, and other publications, in-person and online training, and real-time support. For a curated list of standards-based resources, visit AllRise.org/standards.

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Target Population Eligibility and exclusion criteria for treatment court are predicated on empirical evidence indicating which individuals can be served safely and effectively. Candidates are evaluated expeditiously for admission using valid assessment tools and procedures.

PROVISIONS:

A. �OBJECTIVE ELIGIBILITY AND EXCLUSION CRITERIA

Treatment court eligibility and exclusion criteria are defined objectively, specified in writing, and communicated to a wide range of potential referral sources, including judges, bail magistrates, law enforcement personnel, pretrial services, jail staff, defense attorneys, prosecutors, treatment professionals, community supervision officers, and peer recovery support specialists. The treatment court team does not apply subjective criteria or personal impressions—such as a candidate’s perceived motivation for change, attitude, optimism about recovery, likely prognosis for success, or complex service needs to determine their eligibility for the program.

B. PROACTIVE OUTREACH

The treatment court team makes proactive efforts to identify and engage potentially eligible persons early in the legal case process, when they are most likely to accept referral offers and succeed in the program. Promising outreach strategies include educating defense attorneys, bail magistrates, law enforcement, pretrial services officers, and other criminal justice and treatment professionals about the benefits of treatment court and the referral process; ensuring that pretrial defendants are informed about treatment court soon after arrest; posting informational materials at the courthouse, arrest processing facility, pretrial detention facility, and other areas; and offering immediate voluntary preplea services while persons are awaiting legal case filing and disposition.

C. �HIGH-RISK AND HIGH-NEED PARTICIPANTS

The treatment court serves high-risk and high-need individuals. These are individuals who (1) are at significant risk for committing a new crime or failing to complete less intensive dispositions like probation, and (2) have a moderate to severe substance use disorder that includes a substantial inability to reduce or control their substance use, persistent substance cravings, withdrawal symptoms, and/or a pattern of recurrent substance use binge episodes (i.e., use often substantially exceeds the person’s intentions or expectations). For treatment courts serving persons who may not have a substance use disorder (e.g., mental health courts, veterans treatment courts), being high need also includes having a serious or persistent mental health disorder or other significant treatment or social service needs, such as traumatic brain injury, insecure housing, or compulsive gambling. If serving only high-risk and high-need persons is not feasible for a treatment court—e.g., because of legal policy constraints—the program develops alternative tracks with modified treatment and supervision services designed for persons with lower risk or need levels. If a treatment court develops alternative tracks, it does not serve participants with different risk or need levels in the same counseling groups, residential programs, recovery housing, or court status hearings.

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D. �VALID ELIGIBILITY ASSESSMENTS

Candidates for treatment court are assessed for their eligibility using both a validated risk-assessment tool and a clinical assessment tool. The risk-assessment tool has been demonstrated to predict criminal recidivism, probation or parole revocations, and serious technical violations in treatment courts and other community corrections programs and is validated, to the extent feasible, for the jurisdiction’s population of treatment court candidates. For treatment courts serving persons with substance use disorders, the clinical assessment tool evaluates the formal diagnostic criteria for a moderate to severe substance use disorder, including substance cravings, withdrawal symptoms, binge substance use patterns, and a substantial inability to reduce or control substance use. Candidates are screened routinely for symptoms of a mental health or trauma disorder and referred, if indicated, for an in-depth evaluation of their treatment needs to ensure access to needed mental health, trauma, or integrated co-occurring disorder treatment. If validated tools are unavailable for some individuals in the jurisdiction’s candidate pool or are not available in an individual’s native language, the program (1) ensures that a competent translator administers the items when necessary and (2) engages a trained evaluator to solicit confidential feedback about the clarity and relevance of the tool it is using and to validate the tool among candidates to the program. Assessors are trained and proficient in the administration of the tools and interpretation of the results and receive booster training at least annually to maintain their assessment competence and stay abreast of advances in test development, administration, and interpretation.

E. �CRIMINAL HISTORY CONSIDERATIONS

The treatment court may exclude candidates from admission based on their current charges or criminal history if empirical evidence demonstrates that persons with such charges or histories cannot be served safely or effectively in a treatment court. Persons charged with selling drugs or with offenses involving violence, or who have a history of such offenses, are not categorically excluded from treatment court, barring statutory or other legal provisions to the contrary, and are evaluated on a case-by-case basis.

F. � TREATMENT AND RESOURCE CONSIDERATIONS

Unless needed services or resources are available in other programs, candidates are not excluded from treatment court because they have a co-occurring substance use and mental health or trauma disorder, medical condition, inadequate housing, or other specialized treatment or social service needs.

The treatment court does not impose admission requirements that disproportionately exclude persons of low socioeconomic status or those with limited access to recovery capital, such as preconditions for stable housing, transportation, or payment of program or treatment costs. Monetary conditions, if required, are imposed on a sliding scale in accordance with participants’ demonstrable ability to pay and at amounts that are unlikely to impose undue stress on participants, which may impede treatment progress. Candidates are not excluded from treatment court because they have been prescribed or need medication for addiction treatment (MAT), psychiatric medication, or other medications and are not required to reduce or discontinue the medication to complete the program successfully.

Note: Commentary and references for this standard are being revised for clarity and ease of use. Revised commentary and references will be added as they become available.

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Roles and Responsibilities of the Judge The treatment court judge stays abreast of current law and research on best practices in treatment courts and carefully considers the professional observations and recommendations of other team members when developing and implementing program policies and procedures. The judge develops a collaborative working alliance with participants to support their recovery while holding them accountable for abiding by program conditions and attending treatment and other indicated services.

PROVISIONS:

A. JUDICIAL EDUCATION

The judge attends training conferences or seminars at least annually on judicial best practices in treatment courts, including legal and constitutional standards governing program operations, judicial ethics, evidence-based behavior modification practices, and strategies for communicating effectively with participants and other professionals. The judge also receives sufficient training to understand how to incorporate specialized information provided by other team members into judicial decision making, including evidence-based principles of substance use and mental health treatment, complementary interventions and social services, community supervision practices, drug and alcohol testing, and program performance monitoring.

B. JUDICIAL TERM

The judge is assigned to treatment court on a voluntary basis and presides over the program for no less than two consecutive years. Participants ordinarily appear before the same judge throughout their enrollment in the program. If the judge must be absent temporarily because of illness, vacation, or similar reasons, the team briefs substitute judges carefully about participants’ performance in the program to avoid inconsistent messages, competing demands, or inadvertent interference with treatment court policies or procedures. When judicial turnover is unavoidable because of job promotion, retirement, or similar reasons, replacement judges receive training on best practices in treatment courts and observe precourt staff meetings and status hearings before taking the treatment court bench.

If feasible, replacement judges are assigned new participants’ cases, while the predecessor judge oversees prior cases to discharge.

C. PRECOURT STAFF MEETINGS

The judge attends precourt staff meetings routinely and ensures that all team members contribute their observations about participant performance and provide recommendations for appropriate actions. The judge gives due consideration to each team member’s professional expertise and strategizes with the team to intervene effectively with participants during status hearings.

D. STATUS HEARINGS

Participants appear in court for status hearings no less frequently than every two weeks during the first two phases of the program or until they are clinically and psychosocially stable and reliably engaged in treatment. Some participants may require weekly status hearings in the beginning of the program to

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All Rise | Adult Treatment Court Best Practice Standards 5 provide for more enhanced structure and consistency, such as persons with co-occurring mental health and substance use disorders or those lacking stable social supports. Participants continue to attend status hearings on at least a monthly basis for the remainder of the program or until they are in the last phase and are reliably engaged in recovery support activities that are sufficient to help them maintain recovery after program discharge. During status hearings, the judge interacts with participants in a procedurally fair and respectful manner, develops a collaborative working alliance with each participant to support the person’s recovery, and holds participants accountable for complying with court orders, following program requirements, and attending treatment and other indicated services. Evidence reveals that interactions averaging at least 3 minutes are required to achieve these aims. The judge conveys a respectful and collaborative demeanor and employs effective communication strategies to develop a working alliance with participants, such as asking open-ended questions to generate constructive dialogue, keeping an open mind about factual disputes and actions under consideration, taking participants’ viewpoints into account, showing empathy for impediments or burdens faced by participants, explaining the rationale for their judicial decisions, expressing optimism about participants’ chances for recovery, and providing assurances that staff will be there to support them through the recovery process.

E. JUDICIAL DECISION MAKING

The judge is the ultimate arbiter of factual disputes and makes the final decisions concerning the imposition of incentives, sanctions, or dispositions that affect a participant’s legal status or liberty interests. The judge makes these decisions after carefully considering input from other treatment court team members and discussing the matter with the participant and their legal representative in court. The judge relies on the expertise of qualified treatment professionals when setting court-ordered treatment conditions. The judge does not order, deny, or alter treatment conditions independently of expert clinical advice, because doing so may pose an undue risk to participant welfare, disillusion participants and credentialed providers, and waste treatment resources.

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COM M E NTARY

Judicial leadership of a multidisciplinary team and one-on-one communication between the judge and participants in court are among the defining features of a treatment court (All Rise, 1997). Although many programs offer communi-ty-based treatment and supervision in lieu of prosecution or incarceration, only in treatment courts do judges confer routinely with treatment and social service professionals (often outside of court) to gauge participant performance and share expertise, or to offer advice, encouragement, support, praise, and admonitions to participants during ex-tended court interactions. Not surprisingly, therefore, a good deal of research has focused on the impact of the judge in treatment courts and has examined how judicial interactions with participants and other team members impact public health and public safety outcomes. Results confirm that how well judges fulfill their roles and responsibilities in treatment courts has an outsized influence on program effectiveness, public safety, and cost-effectiveness. Barring evidence to the contrary, practitioners should assume that the standards contained herein apply to all judicial officers working in treat-ment courts.

Studies in treatment courts have not compared out-comes between judges and other judicial officers such as magistrates or commissioners. Researchers have, however, reported comparable benefits from court hear-ings presided over by magistrates or commissioners in adult drug courts and other court diversion dockets (Marlowe et al., 2004a, 2004b; Trood et al., 2022).

A. JUDICIAL EDUCATION

Judges rarely acquire the knowledge and skills required to preside effectively in treatment courts from law school or graduate school curricula (Berman & Feinblatt, 2005; Farole et al., 2004; Holland, 2011). Although most states mandate continuing judicial education (CJE) for judges, a substantial minority of states require only generic continuing legal educa-tion (CLE) suitable for all lawyers (Murphy et al., 2021). Most CJE and CLE courses focus on substantive knowledge of case precedent, statutory law, evidentiary rules, ethics, and court operations, and they often pay insufficient attention to other critical aspects of judging, such as learning how to communi-cate effectively with litigants, work collaboratively with non-le-gal professionals, manage job stress and burnout, and operate in a way that is consistent with best practices for rehabilitation and crime prevention (National Center for State Courts, 2017;

National Judicial College of Australia, 2019). Unless judges seek out curricula designed specifically for treatment courts or other therapeutic justice programs, they are unlikely to learn about evidence-based practices in rehabilitation, conflict resolution, or crisis management (Murrell & Gould, 2009).

Although judges’ temperaments, attitudes, and ethical values have been shown to influence their professional conduct and decision making, studies confirm that specialized judicial education can counterbalance these factors, raise judges’ awareness of the disease model of addiction and the efficacy of rehabilitation (Lightcap, 2022; Maffly-Kipp et al., 2022), and increase adoption of evidence-based practices (Spohn, 2009;

Ulmer, 2019).

Studies have not determined how frequently judges should receive continuing education on specific topics; however, researchers have found that outcomes in drug courts were significantly better when the judge and other team members attended training workshops or conferences at least annually on topics relating generally to treatment court best practices (Carey et al., 2008, 2012; Shaffer, 2011). Given the available evidence, judges should receive training at least annually on practices relating to their roles and responsibilities in treat-ment court, including legal and constitutional standards gov-erning program operations, judicial ethics, evidence-based behavior modification procedures for applying incentives and sanctions, and strategies for communicating effectively with participants and other professionals (Meyer, 2017a, 2017b;

Meyer & Tauber, 2017).

Treatment court judges also require sufficient training to understand how to incorporate specialized information provided by other team members into their judicial decision making, including evidence-based principles of substance use and mental health treatment, complementary interven-tions and social services (e.g., vocational training, housing services), community supervision (e.g., probation field visits, core correctional counseling practices), drug and alcohol testing, and program performance monitoring (Bean, 2002;

Hora & Stalcup, 2008). Based on the available evidence on how often they should receive training on these topics.

However, such training should be frequent enough to ensure that treatment court judges comprehend the information being provided to them by program participants and other team members and the implications of that information for fair and effective judicial decision-making.

Judges commonly report that inadequate funding and a lim-ited ability to spend time away from court are their primary barriers to attending continuing education programs (Murphy et al., 2021). The increasing availability of online webinars and distance-learning programs has made it more affordable and feasible for judges to stay abreast of evidence-based practices. Treatment court judges should use these and other resources to hone their skills and optimize program outcomes.

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Resources

All Rise, the National Treatment Court Resource Center, the GAINS Center of the Substance Abuse and Mental Health Services Administration (SAMHSA), and many other organizations offer open-access publications and webinars on a range of topics related to best practices in treatment courts and other court-based rehabilitation programs. Many courses are preapproved or approvable for CJE and CLE credits, thus avoiding duplication of educational requirements.

B. JUDICIAL TERM

The judge is assigned to treatment court on a voluntary basis and presides over the program for no less than 2 consecutive years. Participants in treatment courts often require substan-tial structure and consistency to change their entrenched maladaptive behavioral patterns. Unstable staffing arrange-ments, especially when they involve the central figure of the judge, are apt to exacerbate the disorganization in partici-pants’ lives. This process may explain why outcomes decline significantly in direct proportion to the number of judges before whom participants must appear.

Judges, like all professionals, require time and experience to accustom themselves to new roles and perform novel tasks effectively and efficiently. Not surprisingly, therefore, judges tend to be least effective in their first year on the treatment court bench, with outcomes improving significantly in the second year and thereafter (Finigan et al., 2007).

A study of 69 drug courts found significantly lower recidivism and nearly three times greater cost savings when judges presided over the programs for at least 2 consecutive years compared to those who served for a shorter period (Carey et al., 2008, 2012). The researchers also reported larger reductions in recidivism when judicial assignments were voluntary and the judge’s term on the drug court bench was indefinite in duration.

Studies have also determined that rotating judicial as-signments, especially when the rotations occurred every 1 to 2 years, were associated with poor outcomes in drug courts, including increased rates of recidivism in the first year (Finigan et al., 2007; National Institute of Justice, 2006; NPC Research, 2016).

A long-term longitudinal study of two drug courts found that the best effects on recidivism were associated with appearances before one consistent judge throughout the drug court process, whereas improvements in recidivism were about 30% smaller when participants appeared before two or more judges (Goldkamp et al., 2001).

The studies to date have addressed regular judicial as-signments to the drug court bench and did not focus on temporary absences due to illness, vacations, holidays, or unavoidable scheduling conflicts. Assuming that judicial ab-sences are predictable and intermittent, there is no reason to believe that temporary substitutions of another judge should seriously disrupt participants’ performance or interfere with successful outcomes. To avoid negative repercussions from temporary judicial absences, the presiding judge and other staff members should brief substitute judges carefully about participants’ progress in the program, so they do not deliver conflicting messages, impose competing demands, or inadvertently interfere with treatment court policies or procedures.

When judicial turnover is unavoidable because of job pro-motion, retirement, or similar reasons, carefully orienting new judges is critical to avoid erosion in program operations and effectiveness. Before taking the treatment court bench, replacement judges should complete live or online training describing the key components of treatment courts and best practices for enhancing outcomes in the programs (Carey et al., 2012; Shaffer, 2011). If feasible, replacement judges should attend precourt staff meetings and status hearings be-fore the transition to learn how the program operates and why.

In addition, newly appointed judges should be assigned the cases of participants who are new to the program, if possible, while the predecessor judge oversees prior cases to dis-charge. This process maintains continuity in case processing, allows the new judge to observe how the predecessor judge intervenes in treatment court cases, and provides opportuni-ties for ongoing advice and consultation from an experienced colleague. If the predecessor judge cannot remain on the treatment court bench long enough for previously enrolled par-ticipants to complete the program, the judge should at least continue to oversee the cases until participants are clinically and psychosocially stable and have developed a constructive working alliance with another staff member, such as a treat-ment professional or supervision officer. (For the definitions of clinical stability and psychosocial stability, see the Incentives, Sanctions, and Service Adjustments standard.)

C. PRECOURT STAFF MEETINGS

Precourt staff meetings are a key component of treatment court (All Rise, 1997). Team members meet frequently in a collaborative setting to review participant progress, share professional observations and expertise, and offer recommendations to the judge about appropriate respons-es to participants’ performance in the program (see the Multidisciplinary Team standard). Precourt staff meetings enable team members to discuss information that may shame or embarrass participants if discussed in open court, offer recommendations or tentative conclusions that may change upon consideration of additional information, RFP No. S-19800-00014538 – Veterans Treatment Court Program Expansion Consulting Services Attachment K file:///Users/gloria/Documents/%20%e2%80%a2%20J%20O%20B%20S%20%e2%80%a2/DCP/DCP141%20ABI%20Toolkit/copy/%20https:/www.nashia.org/cj-best-practice-guide-attachments-resources-copy

All Rise | Adult Treatment Court Best Practice Standards 8 and prepare for their interactions with participants in court (Christie, 2016; McPherson & Sauder, 2013; Roper & Lessenger, 2007). Most important, staff meetings en-sure that the judge has sufficient background information about each case to be able to focus attention on delivering informed responses and interventions for participants and reinforce treatment plan goals. Staff should not spend court time tracking down and reviewing progress information or debating uncontested factual matters (e.g., counseling at-tendance, confirmed drug test results), as in traditional court hearings. Studies find that the most effective drug courts require ongoing attendance at precourt staff meetings by the judge, defense counsel, prosecutor, treatment representa-tive(s), supervision officer(s), and program coordinator.

A study of 69 drug courts found that programs were roughly 50% less effective at reducing crime and 20% less cost-effective when any one of these team mem-bers, especially the judge, was absent frequently from staff meetings (Carey et al., 2012). Qualitative studies have similarly reported that when judges did not attend precourt staff meetings, independent observers rated them as being insufficiently informed about participants’ progress to interact effectively with the participants in court (Baker, 2013; Portillo et al., 2013).

As the leader of the treatment court team, the judge is responsible for overseeing precourt staff meetings, ensur-ing that all team members contribute pertinent information, giving due consideration to each team member’s profession-al input, reaching tentative conclusions about uncontested factual matters (which may change upon learning addi-tional information from the participant or the participant’s legal representative in court), and explaining their judicial reasoning to the treatment court team. Failing to attend precourt staff meetings and perform these vital functions undermines the treatment court model and contributes to ineffective decision making and outcomes. (For a discussion of evidence-based strategies for conducting precourt staff meetings, see the Multidisciplinary Team standard.)

D. STATUS HEARINGS

Status hearings are the central forum in treatment courts.

During status hearings, participants and the multidisciplinary team come together in the courtroom to review participant progress, underscore the program’s therapeutic objectives, reinforce its rules and procedures, ensure accountability for participants’ actions, celebrate success, welcome new graduates back as healthy and productive members of the community, and call upon alumni to be of service in helping current participants find their way to recovery. A substantial body of research underscores the critical importance of status hearings in treatment courts and has identified the optimum frequency of hearings and promising in-court prac-tices to enhance outcomes.

Frequency of Status Hearings in Adult Drug Courts

Adult drug courts achieve the best outcomes when partici-pants attend status hearings biweekly (every 2 weeks) during the first one or two phases of the program (depending on how programs arrange their phase structure), and at least monthly thereafter for the remainder of the program or until they are in the…