Y25-1063-KC_Attachment_A_-_ADC_Policies_and_Procedures.pdf

ORANGE COUNTY

ADULT DRUG COURT PROGRAM POLICIES

AND PROCEDURES MANUAL

Orange County Adult Drug Court Program 425 North Orange Avenue, Suite 325

Orlando, Florida 32801 Main: 407-836-0419 Fax: 407-836-0528

Y25-1063-KC, Attachment A

Table of Contents

INTRODUCTION

VISION STATEMENT

MISSION STATEMENT

GOALS AND OBJECTIVES

ETHICS AND CONFIDENTIALITY STATEMENT

TARGET POPULATION

ANTI-DISCRIMINIATION STATEMENT

ELIGIBILITY AND DISQUALIFICATION CRITERIA

ELIGIBILITY CRITERIA

DISQUALIFICATION CRITERIA

MULTIDISCIPLINARY TEAM

COMMUNICATION BETWEEN TEAM MEMBERS

DRUG COURT PRE-COURT STAFFING AND STATUS HEARINGS

TEAM TRAINING

PROGRAM OPERATIONS

CENSUS AND CASELOADS

REFERRAL AND SCREENING

PARTICIPANT AGREEMENT AND COURT ORDER

PARTICIPANT RULES AND CODE OF CONDUCT

COSTS AND OTHER RELATED FINANCIAL OBLIGATIONS

TREATMENT PROTOCOL

COMPLEMENATARY SERVICES

COMMUNITY PARTNERSHIPS

DRUG TESTING

BEHAVIOR RESPONSES

PHASE PROMOTION

DRUG COURT PROGRAM DISCHARGE

PROGRAM EVALUATION

TREATMENT PROGRAM MONITORING AND DESK REVIEW

INTRODUCTION

The Orange County Adult Drug Court Program (ADCP) is a diversionary and post adjudicatory problem-solving court program created to provide therapeutic interventions for adults suffering from a substance use disorder who have become involved in the criminal justice system. The program provides for the identification, evaluation, case management and placement of adults diagnosed with a substance use disorder into appropriate levels of treatment to address underlying criminogenic needs as an alternative to the person entering the traditional criminal justice process.

VISION STATEMENT

The Orange County Adult Drug Court Program is committed to improving outcomes for participants while maintaining safety and accountability in our community.

MISSION STATEMENT

The Orange County Drug Court Program unites the judiciary, criminal justice entities, substance abuse treatment providers, and the community into one multi-disciplinary team working together to reduce substance use and recidivism of our participants and restoring them to productivity within our community.

GOALS AND OBJECTIVES

The Goals and Objectives of the ADCP are established to provide early intervention and appropriate treatment and support services for program participants while also holding them accountable for their actions.

GOAL 1: TO PROVIDE EARLY SCREENING, ASSESSMENT AND COURT

INTERVENTION

Objective 1: 75% of all people referred to the program will receive contact by a program case manager within two (2) business days of referral receipt.

Objective 2: 75% of all people referred to the program will have a drug court program office screening scheduled (not necessarily completed) within three (3) business days of referral receipt.

Objective 3: 100% of all completed referrals received by the ADCP will be entered into the Drug Court Case Management system (DCCM) within two (2) business days of referral receipt.

Objective 4: 100% of all people referred to ADCP will be assigned to a court case manager within two (2) business days of referral receipt.

Objective 5: 100% of referral updates received by the ADCP will be entered into

DCCM within one (1) business day of referral update receipt.

Objective 6: 75% of all referrals received by the ADCP will either be referred to the treatment provider or returned to the division within one (1) business day of that determination being made and 100% of all eligible referrals will be referred or returned within two (2) business days.

Objective 7: All required paperwork or appointments will begin to be obtained or scheduled within ten (10) business days of notification to the ADCP of the requirement.

GOAL 2: TO PROVIDE EFFECTIVE SUPERVISION

Objective 1: 100% of participants will receive intensive court supervision including regular hearings, tracking of progress, and behavior responses.

Objective 2: 85% of participants receiving program services will reduce the frequency of substance use as measured by substance testing results.

Objective 3: 70% of admitted participants will complete the program successfully.

GOAL 3: TO PROVIDE AN INTEGRATED PROGRAM OF DRUG TREATMENT,

SUBSTANCE ABUSE EDUCATION, AND REHABILITATION

SERVICES.

Objective: 1: 100% of referrals will be assessed using evidence-based tools to determine the appropriate level of care.

Objective 2: 100% of program participants will be admitted into treatment services at the appropriate level of care as measured by treatment provider verification reports.

Objective 3: 80% of participants will be employed or enrolled in school upon graduation as measured by the ADCP discharge questionnaire.

GOAL 4: TO PROMOTE PUBLIC SAFETY BY REDUCING RECIDIVISM.

Objective 1: 15% recidivism rate; no more than 15% of clients discharged from the program will be convicted of a new law violation (excluding traffic offenses) within a 12-month post-discharge and no more than 25% of graduates will be convicted of a new law violation within a 36-month post-discharge.

ETHICS AND CONFIDENTIALITY STATEMENT

ETHICS

All persons and/or agencies participating in the implementation, administration, and/or operation of the ADCP will operate under the strictest guidance of the ethics governing their respective organization and/or profession. They will conduct themselves, when working with the public and the program participants, in a manner so as not to compromise these ethics, setting an example of exemplary professional conduct that will gain and maintain the respect and support of the program.

CONFIDENTIALITY

All matters regarding a program participant, not considered by law to be a matter of public record, will be held by program staff, participant agencies, and the multi-disciplinary team in the highest level of confidentiality according to state and federal confidentiality laws. All public records requests received by the ADCP will be referred to the agency who owns the native documentation requested.

TARGET POPULATION

ANTI-DISCRIMINIATION STATEMENT

The ADCP will not discriminate based on race, religion, gender, ethnicity, age, disability, sexual orientation, sex, national origin, marital status, socioeconomic status, or political affiliation.

The ADCP will target the following population:

• Adults (18 years of age or older)

• Charged with an eligible offense

• Assessed as High Risk/High Need on a validated assessment tool

• Assessed as having a substance use disorder on a validated assessment tool

ELIGIBILITY AND DISQUALIFICATION CRITERIA

ELIGIBILITY CRITERIA

Consideration for admission to the ADCP will be limited to those people who:

1. Are competent.

2. Are charged with and eligible offense as outlined in Florida Statute 397.334. Any misdemeanor or nonviolent felony under chapter 810 or any other felony offense that is not a forcible felony as defined in s. 776.08.

a. Eligibility for the Diversion track is determined by the State Attorney’s

Office. Anyone denied for Diversion may File a Motion for Reconsideration as a post-plea/probation participant. The Judge makes the final eligibility determination for any post-plea/probation referral.

3. Have been assessed by a treatment provider and diagnosed with a substance use disorder.

4. The court determines is amenable to the services available through the ADCP.

5. Have a Criminal Punishment Code scoresheet total sentence points under s.921.0024 of 60 points or fewer after including points for the case or violation.

6. Are willing to voluntarily participate in the program after the court has explained the purpose of the program.

DISQUALIFICATION CRITERIA

People will be ineligible for participation in the ADCP based on the following guidelines:

1. The underlying offense is a forcible felony as defined in s. 776.08.

2. After assessment by a treatment provider the person is not diagnosed with a substance use disorder.

3. The person is found by the court not to be amenable to the services available through the ADCP.

a. If adequate treatment is available, potential participants are not disqualified from participation because of co-occurring mental health disorders, medical conditions, or use of legally prescribed medication.

4. An individual’s inability to pay fees or housing status will not be used as a reason to disqualify the individual from the ADCP.

http://www.leg.state.fl.us/statutes/index.cfm?mode=View%20Statutes&SubMenu=1&App_mode=Display_Statute&Search_String=drug+court&URL=0300-0399/0397/Sections/0397.334.html http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=drug%20court&URL=0700-0799/0776/Sections/0776.08.html http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=drug%20court&URL=0900-0999/0921/Sections/0921.0024.html https://ninthcircuit-my.sharepoint.com/personal/ctadks1_ocnjcc_org/Documents/Desktop/a.%09For%20post-plea/probation%20track:%20the%20underlying%20offense%20is%20a%20nonviolent%20felony.%20The%20term

MULTIDISCIPLINARY TEAM

The purpose of the multidisciplinary team is to provide a vehicle for decision making regarding program participants. Team members collectively make recommendations to the judge about a participant’s admission, progress, behavior responses, and discharge from the ADCP. The team composition is such that all facets of the system are available to provide input and recommendations to the judge. Every member of the team attends all pre-court staffing and court sessions. Each member of the team is also offered the opportunity to attend trainings and conferences where best practice standards are reviewed on an annual basis.

TEAM MEMBERS

Drug Court Judge: trial court judge who leads the multidisciplinary team. Makes all final factual decisions concerning the imposition of behavior responses after getting feedback from the team and participant. Maintains a courtroom environment that emphasizes procedural fairness and mutual respect. Works with the multidisciplinary team to ensure that programs are abiding by current court policies, procedures, and best practice standards.

Drug Court Program Office (Coordinator, Court Case Managers, Peer Support):

provides administrative support to the multidisciplinary team. Works to facilitate communication across the team to ensure that up to date information on each participant is available to all team members in advance of court sessions. Monitors participant program compliance regarding agreement obligations. Makes referrals to outside agencies to address underlying needs for each participant as needed.

Assistant State Attorney: represents the State and any victims in court proceedings.

Reviews each participant's criminal history and can present any concerns to the multidisciplinary team. Has final approval over any cases in the diversion track; is also asked to provide input for cases entering the program on the probation track.

Assistant Public Defender (Defense counsel): represents the rights and interests of program participants. Explains their rights to each participant and the ramifications of waivers related to speedy trial and hearsay that are necessary for program participation prior to program entry. Reviews the program Agreement and Order with the client prior to program entry. Defense counsel will advise their client that certain information related to client behavior in the program will be shared among team members after the client signs appropriate releases of information. Defense counsel will only share information with the team that is not considered attorney/client privilege.

Department of Corrections or County Probation (Probation Officer): provides community supervision for program participants including home visits, employment verification, and drug testing.

Treatment Provider: direct service provider for outpatient or inpatient treatment services, clinical case management, and drug testing for program participants.

Conducts an initial and ongoing assessments to develop and maintain individualized treatment plans. Reviews the proposed treatment plan/recommendation with the participant prior to program entry. Provides weekly updates on each participant’s progress in treatment and any recommendations for improved outcomes for each participant.

Other Community Service Providers: the team also includes representatives from CareerSource and HOPE Florida to facilitate wrap around service referrals.

COMMUNICATION BETWEEN TEAM MEMBERS

Communication between team members is a vital part of the ADCP. This communication may be in the form of in person, email, facsimile, DCCM data entry, or telephonic conference. Consent for such communication between team members is obtained from the participant during the screening process. In addition, each team member signs the DCCM User Confidentiality and Privacy Statement form.

Such communication is limited to informing other team members about participation and progress prior to or while in treatment; including, but not limited to, diagnosis, attendance, cooperation, progress, and prognosis. Should a member of the team identify that a matter requires resolution prior to the participant’s next scheduled court date (i.e., recalling a capias), the initiating team member will email all appropriate team members simultaneously. This email should be clear and to the point, always including the Judge, the Drug Court Coordinator, the Assistant State Attorney, and the Public Defender/Defense Attorney. Any additional team members should be included based upon the issue and participant being addressed.

Information that should be shared among team members is outlined in the Policy and Procedures Manual, DCCM Data Entry Protocol (Appendix H), and program Administrative Orders (Appendix A).

The ADCP strives to host quarterly meetings with team members and stakeholders to address any opportunities for improvement in either service provision or communication.

DRUG COURT PRE-COURT STAFFING AND STATUS HEARINGS

All multidisciplinary-team members attend pre-court staffing and status hearings on a consistent basis. Team members attend pre-court staff meetings to review participant progress, recommend appropriate actions to improve outcomes, and prepare for status hearings in court. Pre-court staff meetings are closed to participants and the public.

The judge may allow other people to attend staffing on an as needed basis. Any person who attends staffing must sign the DCCM Confidentiality and Privacy Statement form prior to attendance.

Progress reports, notes, and treatment recommendations are developed by various team members and disseminated to the multi-disciplinary team prior to each pre-court staffing. The status hearing takes place immediately after pre-court staffing. During the pre-court staffing and status hearing, team members contribute relevant information and recommendations. The judge considers input from all team members and the participant before making final decisions about behavior responses. The judge also provides the participant with and explanation and basis for the final decision of the court during the status hearing.

TEAM TRAINING

All team members are offered training in best practice standards through attendance at the National Association of Drug Court Professionals for Florida Association of Drug Court Professionals conferences as funding is available. Information about other webinars and trainings are sent to team members as they are received by the ADCP.

Prior to beginning to work with the ADCP, all new team members and staff will be sent an email including the ADCP Policies and Procedures Manual, Florida Adult Drug Court Best Practice Standards and a link to the All Rise E-Learning Center’s web-based training modules on Best Practice Standards. All new staff will be required to complete the modules and provide the certificate of completion to the Problem Solving Court Manager

PROGRAM OPERATIONS

CENSUS AND CASELOADS

The adult drug court will serve as many eligible individuals as practicable while adhering to best practice standards.

CENSUS

There is no cap on the number of participants the adult drug court may serve. The number of participants active in the program is predicated on local need, obtainable resources, and the program’s ability to apply best practice standards. If the census reaches 125 active participants, program operations will be monitored carefully to ensure they remain consistent with best practice standards.

SUPERVISION CASELOADS

The probation officer on the adult drug court team will not have a caseload greater than 50 participants. Probation supervision includes monitoring participant performance and reporting compliance between and during court staffings and hearings.

CLINICIAN CASELOADS

Clinicians have caseloads that permit sufficient opportunities to assess participant needs and deliver adequate and effective treatment services. Caseloads are also governed by applicable licensing entities.

If clinician caseloads exceed certain thresholds program operations will be monitored carefully to ensure they remain consistent with best practice standards:

All%20Rise%20E-Learning%20Center%20web-based%20modules All%20Rise%20E-Learning%20Center%20web-based%20modules

• 50 active participants for clinical case management

• 40 active participants for clinicians providing individual therapy

• 30 active participants for clinicians providing both clinical case management and individual therapy

COURT CASE MANAGER CASELOADS

The ADCP carefully monitors the caseloads of court case managers to ensure adequate case management for participants.

REFERRAL AND SCREENING

Per AO 2018-07-03 the referral of a defendant into the ADCP may be made by any of the criminal trial divisions with no plea taken, and may be made by defense counsel, the State Attorney’s Office, the Court, the Drug Court Office, the Pretrial Services Unit of the Department of Corrections, or any other interested party.

During the referral and screening process ADCP requirements are fully explained to potential participants prior to inquiring if they would like to participate in the program.

During screening, court case managers review the court participant handbook (Appendix D) with the participant emphasizing the intensive nature of the program, particularly in the early phases. The handbook also contains written policies and procedures concerning behavior responses and treatment interventions.

ADCP office screening (Appendix C) includes the following evidence-based screening tools:

• Adverse Childhood Experiences (ACE)

• Risk and Needs Triage Tool (RANT or DUI RANT)

• Texas Christian University Drug Screen 5 (TCU 5)

PARTICIPANT AGREEMENT AND COURT ORDER

Upon entering the ADCP, participants receive a clear and comprehensive explanation of their rights from their defense attorney. General program responsibilities and expectations are explained by court case management and treatment and include information about substance testing. This information is also outlined in the court Agreement, Order, and handbook and is reviewed periodically with participants by both court case management and treatment to ensure participants remain cognizant of their obligations.

PARTICIPANT RULES AND CODE OF CONDUCT

Certain behaviors are expected of each participant. These “behavioral objectives” and program participant rules focus on behaviors that are acceptable and indicate the participant’s progress in the program, focusing on the parts of the participant’s life that are affected by identified criminogenic needs. Additional “behavioral objectives” may be added as the participant progresses in the program.

https://ninthcircuit.org/sites/default/files/AO2018-07-03.pdf

As outlined in the court participant handbook, participants are required to abide by the following rules:

Appropriate clothing is always expected. This includes in court and at the treatment facility. Clothing bearing drug or alcohol related themes or promoting, or advertising alcohol or drug use are not allowed. Participants wearing clothing that bears too much skin or that does not fit appropriately may be asked to change. No gang colors or gang clothing shall be worn in court, during treatment, or to any meetings. Sunglasses and hats will not be worn inside the courtroom or to any drug court related meetings.

Participants are expected to attend all scheduled counseling sessions, educational meetings and court sessions unless receiving prior approval by court case management, treatment, or the judge to be excused. Participants must arrive on time and not leave until the session is over. If a participant is late, they will not be allowed to attend the session and will be considered absent. Arrangements must be made with the participant’s counselor to make up missed groups before the participant’s next court appearance. This includes treatment meetings, as well as support group meetings (AA, NA, CA, etc.)

The following participant actions will not be tolerated:

• Threats of violence of any kind to staff or other participants, belligerent behavior, or acts of vandalism to property

• Use and/or possession of illegal drugs and/or alcohol

• Possession of any type of weapon

• Inappropriate sexual behavior or harassment

Participants must notify a multi-disciplinary team member (preferably the court case manager) of any arrest or legal obligations.

While in the courthouse and during court sessions, participants are expected to behave appropriately. The Drug Court Judge shall be addressed with respect. Participants will sit quietly in the audience and cell phones will be silenced.

During court sessions, participants are expected to interact with the Judge by advising the judge of their progress and seek support for any areas causing them frustration or concern.

Participants may not leave their county of residence without prior court and probation (if applicable) approval. All travel requests must be submitted to the assigned court case manager and probation officer (if applicable) at least 30 days prior to proposed travel.

The court case manager and probation officer (if applicable) must approve travel before it is presented to the Judge for final approval. If the participant has a travel related emergency, they must contact the court case manager ASAP. If the participant needs to leave their county of residence on a regular basis for work or other purposes, the Judge may grant the participant general approval to leave their county of residence for that purpose.

COSTS AND OTHER RELATED FINANCIAL OBLIGATIONS

DRUG COURT PARTICIPATION FEE

Each participant is required to pay a drug court participation fee of $900. This flat fee is broken down into three (3) payments of $300 payable to the Orange County Clerk of Court as the participant progresses through program phases. If a participant is unable to pay the fee, the participant can contact their court case manager to start the fee reduction application process.

DRUG COURT PARTICIPATION FEE REDUCATION APPLICATION PROCESS

The program fee may be reduced proportionally based upon a sliding scale taking into consideration a participant’s gross annual income and household size in accordance with the current Federal Poverty Level. The minimum amount that must be paid by all participants is $300. To begin the fee reduction application process participants must complete the form (Appendix C) and submit it to their court case manager.

OTHER COURT ORDERED FINES AND FEES

All participants are expected to make payments on a regular schedule (typically via a court ordered or clerk established payment plan) toward the satisfaction of all court financial obligations including, but not limited to, participation fees, court-imposed fines/fees/costs, and restitution. Participants may be required to show proof of payment to drug court team members. If a participant cannot make a payment, they may discuss their situation with their court case manager or defense attorney to determine how to move forward (i.e., payment plan modification). Per statute, failure to make timely payments on court-imposed fines and fees may result in the participant’s driver’s license being suspended

TREATMENT PROTOCOL

ASSESSMENT AND TREATMENT PLANNING

Individualized treatment plans are developed with the participant’s assigned primary counselor, a master’s level clinician, in conjunction with the participant, case manager, and any additional treatment multi-disciplinary team members as appropriate.

Treatment needs are determined based on evidence-based assessments as administered and scored by appropriately trained personnel.

Assessments are administered pre-admission to determine eligibility and suitability for the program and to inform initial treatment planning. The participant is made aware of the proposed initial treatment plan by their treatment provider prior to signing their drug court agreement.

Treatment providers use the following evidence-based screening and assessment tools (as clinically appropriate) in addition to the screening results provided by the ADCP when developing the participant’s individualized treatment plan:

• Recidivism Risk & Criminogenic Needs: Ohio Risk Assessment System* (ORAS)

• Level of Care: American Society of Addiction Medicine Level of Care (ASAM)

• Diagnosis: In-Depth/Biopsychosocial Assessment

• Trauma: Posttraumatic Stress Disorder Checklist (PCL5)

• Needs & Case Management Targets: Assessment of Recovery Capital, University of Rhode Island Change Assessment scale* (URICA)

• Mental Health: Beck Anxiety Inventory* (BAI), Becks Depression Inventory* (BDI)

• Additional: Adult HOPE Scale* (AHS)

*Should re-administer every 6 months to assess program/treatment efficacy.

TREATMENT PLANNING CONSIDERATIONS

Treatment plans are based on individual assessments. Treatment plans are developed to assist the participant in progressing through the four traditional phases of the ADCP:

Phase 1: Stabilization

Goal: Assist participant in obtaining the resources necessary to meet basic needs and fulfill role obligations. (Stage of Change: Precontemplative-Contemplative)

• Possible areas of focus include housing, transportation, and life skills

• Participants are ready for advancement when they can regularly attend program requirements and/or communicate appropriately regarding absences and obstacles to success.

Phase 2: Intensive Treatment

Goal: Assist participant in identifying personal obstacles and establishing specific clinical goals. (Stage of Change: Contemplative-Preparation)

• Possible areas of focus include triggers, patterns of behavior, and trauma.

• Participants are ready for advancement when they can identify appropriate treatment goals and are willing to begin learning the skills needed to be successful.

Phase 3: Recovery Management

Goal: Assist the participant in developing a sustainable pro-social routine and increase comfort utilizing community resources & support. (Stage of Change: Preparation-

Action)

• Possible areas of focus include long-term goals, community involvement, and relationships.

• Participants are ready for advancement when they have made objective progress on their clinical goals and are actively establishing recovery oriented/pro-social activities & are able to achieve 90 consecutive days of favorable drug testing.

Phase 4: Aftercare

Goal: Monitor participants continued progress in recovery management & assist as needed in addressing new obstacles/returns to use. (Stage of Change: Action –

Maintenance)

• Possible areas of focus include sobriety and additional identified needs/obstacles.

• Participants are ready for graduation when they have achieved identified pro-social and clinical goals, are able to achieve 90 consecutive days of favorable drug testing, and there is reasonable evidence that progress will be maintained after graduation.

TREATMENT MODALITIES AND CURRICULA

Substance abuse and mental health treatment will be administered based on the participant needs AS identified in evidence-based assessments. Treatment will include at a minimum (unless deemed clinically inappropriate):

• Individual Therapy with appropriately trained and licensed substance use/mental health professionals, including, but not limited to Licensed Mental

Health Counselors, Licensed Clinical Social Workers, Licensed Marriage, Couples, and Family Therapists, and/or license eligible Registered Mental Health

Counselor Interns, Registered Clinical Social Worker Interns, and Registered

Marriage, Couples, and Family Therapist Interns under the supervision of a qualified clinical supervisor.

• Group Therapy which follows evidence-based curricula designed to address common needs of participants with substance use disorders including, but not limited to:

o Challenging Criminal Thinking (i.e., Thinking for Good, Moral Reconation

Therapy) o Recovery Management (i.e., The Matrix Model, Mindfulness Based

Sobriety, Stages of Change, 12 Steps) o Trauma Education & Processing (i.e., Seeking Safety, Emotional

Regulation)

In additional to individual therapy and group therapy, participants may be referred to other treatment services that will support their recovery including, but not limited to:

• Trauma Therapy with a clinician trained in Eye Movement and Desensitization and Reprocessing (EMDR)

• Family/Couples Counseling

• Family/Support Education including overdose reversal education

• Medication Assisted Treatment for opioid and/or alcohol use disorder

• Psychiatric Medication Management

• Medically Monitored Detox

• Residential Treatment

Every effort is made to work with treatment providers to provide treatment services at locations and time convenient to participants. When deemed clinically appropriate, telehealth services may be approved by the judge on a case-by-case basis.

MEDICATIONS

All participants must disclose all over-the-counter medications, all prescriptions, all supplements to the treatment case manager prior to taking any of the above.

Prescription medications are only approved with a valid prescription in the participant’s name. Without a valid prescription, a positive drug test result for a prescription substance is unacceptable and will be addressed as an unfavorable test result.

Medical marijuana will be addressed by the judge on a case-by-case basis prior to the participant entering the program. The multi-disciplinary drug court team relies on expert medical input to determine whether a prescription for an addictive or intoxicating medication is medically necessary and whether alternatives are available. The use of any addictive or intoxicating substance will only be authorized if it is determined by competent medical evidence to be medically indicated, if safe and effective alternative treatments are not reasonably available, and if the participant is carefully monitored by a physician with training in addiction psychiatry or addiction medicine. There is a serious risk of morbidity, mortality, or illegal diversion of medications when addiction medications are prescribed by general medical practitioners for addicted patients.

Participants are provided a list of common substances of abuse and other substances, foods, etc. that may interfere with their ability to submit a valid urine sample by their treatment case manager.

EMERGENCY SERVICES AND MEDICAL NECESSITY EXCEPTIONS

Acknowledging that emergency situations may require administration of unapproved prescription medication, the following policy is in place to allow appropriate medical care in such situations. On a case-by-case basis, the participant may be placed on medical leave by the treatment provider while they participate in such treatment.

If a participant is prescribed unapproved medications due to an emergency, the participant must provide appropriate documentation to their treatment provider.

COMPLEMENATARY SERVICES

Participants are referred to complementary treatment and ancillary services to ensure they can complete program requirements while also meeting any additional personal needs. By addressing other services, the program seeks to enhance participant response to substance use disorder treatment, decrease criminal recidivism and maintain long term treatment gains.

Depending on participants needs, complementary services may include consultation regarding medications, housing assistance, transportation assistance, job placement.

trauma-informed services, peer support, criminal thinking interventions, family, or interpersonal counseling, parenting skills, vocational or educational and medical or dental treatment.

The sequence and timing of services are based on the immediate need(s) the participants may have at that time and phase progression in the program.

While in treatment, participants meet with a treatment case manager weekly during the first phase of the program. The treatment case manager assesses whether participants require complementary treatment or services, provides, or refers participants for such services and keeps the team updated on participant progress.

HOUSTING ASSISTANCE

If a participant needs housing, the multidisciplinary team will make a collaborative effort to help the participant find an appropriate place to stay. Safe, stable, and drug -free housing is essential to a participant’s success in the program and in maintaining their sobriety after discharge. Unstable housing does not exclude a participant from entering the ADCP.

WRAPAROUND TREATMENT SERVICES

Trauma informed services, critical thinking interventions, and family/interpersonal counseling are all complementary treatment services that may be added to the treatment curriculum for a participant. Complementary treatment services are there to help maintain the stability of the participant. These services are all evidenced based and conducted by treatment professionals who are also a part of the multidisciplinary team.

ANCIALLARY SERVICES

Educational, vocational, medical, and dental treatment are other services participants are referred to while in the ADCP. Educational and vocational services help the participant acquire and maintain skills that will help them with school and career. While medical and dental services can help maintain stable health throughout the program and beyond.

RECOVERY SUPPORT AND PEERY SUPPORT SPECIALISTS

Upon referral to the ADCP, potential participants are connected with recovery support services to promote treatment engagement, retention, and sustained recovery.

Participants are linked with professionally trained or certified recovery specialists, peer support specialists, or the local recovery community organization (RCO).

CLINICAL CASE MANAGEMENT

Clinical case managers will assist participants with gaining access to all available benefits including but not limited to Social Security Disability Insurance, Medicare and/or Medicaid, veterans’ benefits, transportation assistance, private insurance, assistance from the Agency for Persons with Disabilities, the Substance Abuse and Mental Health Services Administration (SAMHSA), and SSI/SDI Outreach, Access, and Recovery (SOAR) as needed.

COMMUNITY PARTNERSHIPS

The ADCP has developed collaborative partnerships among community-based organizations and other criminal justice agencies. Forming such collaborative partnerships has allowed our program to expand the continuum of services available to participants and informs the community about problem solving court concepts. Below is a list of our most utilized community partners:

Aspire Behavioral Healthcare provides comprehensive community based behavioral healthcare services.

Aspire Behavioral Healthcare, Inc. (traditional Adult Drug Court treatment) 1800 Mercy Drive Orlando, Florida 32808 Phone: 407-875-3700

Aspire Opioid Drug Court Treatment 100 West Columbia Street Orlando, FL 32806 Phone: 407-875-3700

Orange Blossom Family Health Center provides health services for people experiencing homelessness or are low income (below 200% of the current federal poverty guidelines).

Orange Blossom Family Health Center 232 N. Orange Blossom Trail Orlando, Florida 32805 Phone: 407-428-5751

Hope Florida, Florida Department of Children and Family Services helps individuals with an array of services and resources such as job placement, vocational skills, rent assistance and housing.

Phone: 850-300-4323

Recovery Connections of Central Florida helps individuals in crisis struggling with alcohol or drug addiction. Provides peer support, weekly NA/AA meetings, and a sober activities community center.

7912 Forest City Road Suite 101, Orlando, Florida 32810 Phone: 407-732-6837

DRUG TESTING

Appropriate, randomized, and frequent drug testing is a keystone of treatment for substance use disorders and serves as a tool for monitoring the efficacy of the treatment being offered. Drug testing may be conducted through urinalysis (UA), breathalyzer, and/or oral swabs. Drug testing occurs randomly throughout the program.

Participants are required to call a hotline every day to determine if their drug testing phase or color has been called; participants are required to report for drug testing before the facility closes on the same day. Participants are randomly tested at least two times within a seven-day period. There is no maximum number of times a participant may be required to test. Any member of the multi-disciplinary team may request a drug test at any time.

If a participant arrives to the drug testing facility outside of drug testing hours, they will not be tested. If a participant is not able to produce a sample prior to the end of the day’s drug testing hours, they will not be tested.

If a participant misses a drug test, the participant should contact their treatment case manager to arrange to submit a sample as soon as possible (preferably within 24 hours).

TESTING PROTOCOL

Drug and alcohol testing provides an accurate, timely, and comprehensive assessment of unauthorized substance use throughout participant enrollment in the program. The multidisciplinary team will assist participants with managing any barriers to testing such as cost or transportation and will seek to streamline processes so that testing can occur at the time and location of other services whenever possible.

FREQUENT TESTING

1. Drug and alcohol testing is performed frequently to ensure substance use is detected quickly and reliably.

2. Drug and alcohol testing is performed at least twice per week for the duration of intensive phases of adult drug court treatment.

3. Tests that measure substance use over extended periods of time, such as ankle monitors, are applied for at least 90 consecutive days followed by urine or other intermittent testing methods.

4. Breathalyzers or oral fluid tests are utilized spontaneously when recent substance use is suspected or when substance use is more likely to occur, such as weekends or holidays.

RANDOM TESTING

1. The schedule of drug and alcohol testing is random and unpredictable.

2. Participants are required to test on the same day after calling the hotline and determining that their phase or color has been called or being notified that a test has been scheduled.

DURATION OF TESTING

1. Drug and alcohol testing continues throughout the course of program participation to determine whether relapse occurs as other treatment and supervision services are adjusted.

BREADTH OF TESTING

1. Specimens are tested for all unauthorized substances that are suspected to be used by participant.

2. Randomly selected specimens are tested periodically for a broader range of substances to detect new substances that might be emerging in the adult drug court population.

WITNESSED COLLECTION

1. When the collection of test specimens is observed, the witness is a gender appropriate person who has been trained to prevent tampering and substitution of fraudulent specimens.

2. Barring exigent circumstances, participants are not permitted to undergo independent drug or alcohol testing in lieu of being tested by trained personnel assigned to, or authorized by, the adult drug court.

VALID SPECIMENS

1. Test specimens are examined routinely for dilution and adulteration.

ACCURATE AND RELIABLE TESTING PROCEDURES

1. The adult drug court uses scientifically valid and reliable testing procedures and establishes a chain of custody for each specimen.

2. For a positive screening test, a portion of the same specimen is subjected to confirmatory analysis using gas chromatography/mass spectrometry (GC/MS), liquid chromatography/mass spectrometry (LC/MS), or a similarly calibrated test.

3. Drug or metabolite concentrations falling below industry-or manufacturer-recommended cutoffs are not interpreted as evidence of new substance use or changes in participant substance use patterns unless such a determination is based on specialized staff expertise in analyzing toxicology results.

RAPID RESULTS

1. Test results, including the results of confirmation testing, are available to the multidisciplinary team within 48 hours of specimen collection.

POSITIVE TEST POLICY

Abnormal Sample Validity:

Any samples returning from the lab as abnormal validity will be treated as an administrative positive. All samples sent to the lab are checked for signs of tampering or dilution. Participants are advised to avoid excessive water consumption 45 minutes prior to providing a sample. Any samples that are light in color or without color will be sent to the lab and checked for validity. Additionally, any samples that don’t register a temperature will be sent to the lab and checked for validity.

Insufficient Sample Volume:

Samples provided must be enough to reach the top of the black temperature strip on the side of the test cup. Samples less than this will be considered invalid and treated as a no sample, administrative positive. Once a sample has been provided, a second sample or additional sample cannot be provided to make up for the initial sample be insufficient.

Positive Windows:

Participants testing positive are provided a window of time for the substance to work through their system. The lab determines the length of the window based on what substance(s) are found. Day 1 of the window begins on the day of the positive test or the date of last use, whichever is first. During this time tests will be sent to the lab for verification until a negative is received from the lab. Positive tests outside of window or after testing negative will be considered a new positive.

THC Window:

Based on guidelines from toxicology and our lab partners, the initial window for new participants with a history of chronic THC use is 40 days. A participant’s levels will be monitored routinely after a positive test result to ensure the participant is not continuing to use THC.

BEHAVIOR RESPONSES

The implementation of behavior responses is rehabilitative and treatment oriented and will help shape the participant’s behavior during and after discharge from the program.

Graduated incentives and sanctions provide a means of addressing inappropriate behavior and rewarding the appropriate behavior of program participants. It is important for participants to know that the program places just a s much emphasis on incentives for productive behavior and program compliance as it does on sanctioning non-compliant behaviors and program non-compliance.

INCENTIVE RESPONSES

Incentives or “rewards” are given as a positive reinforcement to the participant when they demonstrate progress or success in the program, such as: A+/A/B Team resulting in judicial accolades, applause, being called early during the court session and attending court less frequently; individual awards such as Way to Go participant of the week, entering a fishbowl drawing, receiving a gift card; or other incentives.

SUPERVISION RESPONSES

Supervision responses may be given to participants to address improvements in behavior or reversion to patterns of behavior that are not suitable for remaining within program limits. Supervision responses may include transitional housing, changes in frequency of drug testing or court appearances, curfew, travel pass etc.

THERAPEUTIC RESPONSES

Participants do not receive punitive sanctions if they are otherwise compliant with their treatment and supervision requirements but are not responding to treatment interventions. Reassessment and adjustment of treatment plans may be required and is not used as an incentive or sanction. Adjustments to treatment plans are based on the recommendations of trained treatment professionals considering the clinical needs of the participant’s substance use and mental, physical, social, or emotional health.

SANCTIONS RESPONSES

Sanctions are consequences for non-compliance which include but are not limited to positive/presumptive/missed drug screens, missed individual/group therapy or court ordered meetings, attendance at court ordered groups falls below 85%, not completing community service hours by due date, inappropriate behavior, and missed court dates.

Sanctions include but are not limited to writing a letter of accountability, community service hours, increased attendance at self-help meetings, increased court appearances, incarceration, expulsion from the program.

The multidisciplinary team will reference the behavior response matrix (Appendix F) to determine the most appropriate response to address each participant’s behavior.

Participants are afforded an opportunity to explain their perspective during the court hearing before the judge imposes a behavior response. The judge will also allow a participant’s attorney to assist in providing explanations if the participant is having difficulty articulating themselves for any reason.

While each participant’s situation is reviewed on a case-by-case basis, they will receive responses that are equivalent to those received by other participants in the same phase of the program who are engaged in comparable conduct. The behavior response matrix is set up to take into consideration a participant’s distal and proximal goals. For distal goals, sanctions increase in severity for successive infractions. For proximal goals, a more severe sanction will be imposed.

Jail Sanctions Jail sanctions may be imposed by the judge if needed. Jails sanctions will not last more than 5 days. Participants will have representation at any hearing where their liberty is addressed by the court.

PHASE PROMOTION

Phase promotion is based on the achievement of realistic and defined behavioral goals.

For a participant to phase up they must complete both treatment requirements and other court ordered requirements such as attending peer support group meetings, actively searching for/maintaining employment or education, and any other court ordered classes/requirements.

Treatment phase criteria are indicated in writing and provided by the treatment provider to each participant prior to entering the program through the treatment handbook

(Appendix D). It is explained to the participants that with phase promotion comes greater responsibility. As they move through the phases of the program, while sanctions for infractions may increase in magnitude, incentives/rewards for achievements may decrease and supervision may decrease as trust is built.

A reduction in treatment magnitude or frequency is only recommended if it is found that it is unlikely to cause a relapse. In addition, the frequency of drug and alcohol testing is not reduced unless clinically appropriate. As an alternative to phase promotion, the treatment provider may develop a modified treatment plan for participants who has relapsed or who for therapeutic reasons is deemed inappropriate for phase advancement.

DRUG COURT PROGRAM DISCHARGE

GRADUATION – SUCCESSFUL DISCHARGE

Once a participant has satisfied all requirements the of the ADCP Agreement they will be eligible for graduation. This includes completing the final phase of treatment (typically Aftercare) and drug testing appropriately for at least ninety (90). Participants in the probation track who successfully complete the program may have their probation terminated early. Participants in the diversion track may have their charges dropped by the State Attorney’s Office. The case’s ultimate disposition is dependent on the conditions of the Agreement/Sentence upon program admission.

TERMINATION – UNSUCCESSFUL DISCHARGE

A program participant may be discharged by the judge at any t ime for infract ions including, but not l imited to , the participant requesting discharge, the participant exhibiting behavior in violation of the participant rules and code of conduct, refusal to satisfactorily participate in program requirements, violation of program rules, being arrested, absconding, or probation term expiration.

Participants may request termination from the ADCP directly to the Judge who will consider the request on a case-by-case basis. Participants who are terminated will receive a sentence or disposition for the underlying offense that brought them into the program in the drug court judge’s division.

PROGRAM EVALUATION

Program evaluation design will measure outcomes as outlined in the Goals and Objections section of the Policies and Procedures manual.

PROCESS

Each summer the ADCP reviews data available in the Ninth Judicial Circuit Court case management systems (including the Orange and Osceola County Clerk of Court case management systems and DCCM) to monitor progress toward reaching program goals and objectives.

DISCHARGE QUESTIONNAIRE

A discharge questionnaire (Appendix B) is completed with all participants being discharged from the program.

RECOMMENDATIONS

Based on the outcome of the annual evaluation, program governance documents (including the Policy & Procedures Manual, Agreements/Orders, Administrative Orders, and DCCM Data Entry Protocol) are reviewed and updated as needed to address any deficiencies uncovered.

The outcome of the evaluation is shared with the multidisciplinary team and addressed at the quarterly team meetings and with individual team members as needed

TREATMENT PROGRAM MONITORING AND DESK REVIEW

The ADCP will conduct annual site visits to all work performance sites for vendors under contract with the program in addition to conducting performance desk reviews. In some years this may be replaced by a site visit conducted by Orange County Government.

Monitoring is the process by which the ADCP verifies compliance with all applicable state and federal rules and…