Author: ellag

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From Data to Action: Tackling Racial Disparities with the RED Tool in Treatment Courts 

The Racial and Ethnic Disparities Initiative (REDI) at American University is proud to announce the publication of their article Maintaining fidelity to the treatment court model through evaluation: The racial and ethnic disparities (RED) program assessment tool, as featured in in the Journal of Human Behavior in the Social Environment. This study, which analyzed treatment courts nationwide, utilized the Racial and Ethnic Disparities (RED) Program Assessment Tool (RED tool). The web-based tool collects information on multiple aspects of treatment court programming where racial and ethnic disparities may exist. Additionally, based on the court’s responses, they receive scores on seven out of the eight sections on the tool and an overall score accompanied by recommendations that are generated for courts on how to alleviate racial and ethnic disparities in their program.  

The treatment court model has consistently been proven more effective at reducing recidivism than traditional approaches, such as incarceration or probation. However, treatment court outcomes have been disproportionately positive for white participants, compared to racial and ethnic minority participants. In a recent study with a sample of over 14,000 treatment court participants, African Americans and Hispanics/Latinos had a lower graduation rate than white participants.  

The current study, which was conducted from 2020 to 2022, was based upon the voluntary participation of treatment courts (n=151). The study collected data from nine states, utilizing targeted questions to analyze each court. The RED tool identified existing racial and ethnic disparities within each individual court and recommended steps to promote equity in outcomes.  

The objective of this study was to answer two research questions, which were as follows:  

  1. Do treatment courts have fidelity to the model by completing evaluation on a regular basis to assess program effectiveness?  
  1. Do racial and ethnic disparities exist in treatment court graduation rates? 

Participating treatment courts were scored in seven areas based on their responses to the RED tool: court background, intake criteria, assessments, court team, training, treatment and services, and evaluation and monitoring. The table below compiles the mean score in each category, with higher scores signifying better compliance with best practice standards. These scores are to be used as a baseline for courts to track their progress from their initial assessment to re-assessment after best practice recommendations are implemented.  

Regarding evaluation and monitoring, half of the participating treatment courts reported tracking outcomes in some capacity post-program. However, only 41% of the participating courts provided graduation outcomes based on race and ethnicity, suggesting the other 59% of courts lack the infrastructure to track or examine graduation outcomes based on race and ethnicity.  

The average score of treatment court best practice adherence across all categories for this study was 59.85%. REDI would like to emphasize that these results should not be viewed punitively, but as a testament to the importance of consistent evaluation and adherence to best practice standards with attention to disparities in outcomes and experiences that may exist for minoritized participants. 

The results of this study show evidence of racial and ethnic disparities in treatment court outcomes. Graduation rates were lower on average for minoritized participants (specifically African American and Hispanic participants) than for white participants. See the table below for more information. Furthermore, only 13% of responding treatment courts reported sometimes or always implementing policies to address racial and ethnic disparities in outcomes. 

The majority of the disparities in the sample identified with the RED tool can be rectified by following best practice standards. For example, completing regular and comprehensive evaluations for potential racial and ethnic disparities, as well as aligning with treatment providers that utilize individualized, evidence-based interventions. 

Treatment courts are an important sector of the recovery process for individuals struggling with substance use, connecting participants with resources and ensuring the path to recovery is accessible to all. This September marks the 35th annual National Recovery Month, according to SAMHSA. Established in 1989 to celebrate and destigmatize recovery from substance use and mental health conditions, National Recovery Month recognizes the millions of Americans that have struggled with substance use, and ensures that resources and support are accessible to all who need them.  

Thank you for supporting our work. For any questions or comments, please contact redtool@american.edu. 

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Veterans Treatment Courts: Uplifting Programs and Participants with the RED Tool

A VTC graduate is presented with a handmade quilt upon his program graduation in Buncombe County, North Carolina. Wright, Angeli. “The Frame: Buncombe County Veterans Treatment Court Graduation.” The Asheville Citizen Times, January 25, 2018.

As we reflect on the sacrifices of those who served in our armed forces, it is timely to bring awareness to the countless number of veterans across the country who struggle with mental illness and substance use disorders (SUDs), often stemming directly from their time in combat, which can cause those who served their country to find themselves in the crosshairs of the legal system and even incarceration. Since 2004, veteran treatment courts (VTCs) have used a multi-disciplinary team of professionals from courts, community corrections, treatment agencies, and social service organizations to address veterans’ SUDs and mental health issues, with the purpose of eliminating criminal behavior.

A recent report by the US Bureau of Justice Statistics, published in 2016, estimates that 107,400 veterans were incarcerated in state or federal prison at the time, and that about 8% of all state prisoners and 5% of federal prisoners were veterans. Furthermore, a 2017 study by the Social Psychiatry and Psychological Epidemiology Journal found that about a third of the United States’ 19 million veterans report having been incarcerated at least once.

Veterans are in a uniquely vulnerable position to developing SUDs, especially due to their susceptibility to post-traumatic stress disorder (PTSD), a psychiatric condition that can occur as a result of exposure to extreme trauma. PTSD has been shown to be a significant risk factor for veterans in terms of developing SUDs, with the US Department of Veterans Affairs reporting that more than a fifth of veterans with PTSD also experience SUD, while nearly a third of veterans seeking treatment for SUD experience PTSD. Symptoms of PTSD, which usually manifest within 3 months of a triggering event or series of events, are numerous, and can involve flashbacks, difficulty sleeping, avoidance of triggering thoughts, objects, or situations, depression, and memory loss. It is the intensity of these symptoms and a desire to mitigate them that often leads veterans to develop SUDs and therefore an increased risk of involvement in the criminal justice system, according to the National Institute of Mental Health.

The Racial and Ethnic Disparities Initiative (REDI) at American University (AU) is proud to work with VTCs across the country, using the Racial and Ethnic Disparities (RED) Program Assessment Tool (RED tool) to identify and rectify instances of RED in their programs. Between 2020 and 2023, 14 VTCs from Georgia, Ohio, Oregon, and Wisconsin completed the RED tool. These VTCs’ participation resulted in the accumulation of vital information about the operations of these VTCs, and the services they provide veteran participants. For example, 100% of the VTC respondents reported having at least one Veterans Justice Outreach (VJO) specialist on staff. This is a critical data point, as VJO specialists are instrumental in identifying veterans who could benefit from VTCs and connecting these veterans with the services they need. VJO specialists operate within communities, as an extension of the local justice system, to provide direct outreach and assessment services to veterans that have come in frequent contact with law enforcement, often called “justice-involved veterans.”

The results of the RED Program Assessment Tool also demonstrated that 100% of the VTC respondents reported having their eligibility requirements for program participation in writing. This may seem like a minor detail, but in fact having VTCs with written clear, objective eligibility requirements is critical to mitigating bias in the admissions process and improving participant access, particularly veterans from diverse racial and ethnic backgrounds. 

However, there is always room for improvement, and the results of the RED Program Assessment Tool demonstrated that VTCs are no exception. For example, even though 100% of  the VTC respondents reported having their eligibility requirements in writing, only 57% of those courts reported sharing a copy of those written eligibility requirements with all referral sources. Referrals can come from a variety of sources, such as judges, the VA, defense attorneys, VTC staff, and even friends and family of the veteran experiencing SUDs. If clear and objective written eligibility requirements are not distributed to all possible referral sources, outreach to potential VTC participants becomes difficult. It is crucial that all referral sources receive concrete guidance on who is eligible for VTC programs, which can then increase program referrals. By creating more accessible community resources such as flyers, updated websites, or maintaining a strong connection with the local VA, outreach of accurate and relevant information to these referral sources can be maximized.

By using the RED tool to identify where there are instances of RED in their programming and utilizing REDI’s educational resources for guidance on next steps, VTCs are empowered to ensure that their veterans from diverse racial and ethnic backgrounds are receiving the support they need. VTCs play a critical role in promoting the racial equity of their programming, which can be improved through many avenues such as: implementing culturally intuitive policies, promoting open dialogue, and emphasizing resources for mental health issues and SUDs are only a handful of examples of this.

This Veteran’s Day and every Veteran’s Day, it is important to recognize all of those who have served our country, especially those who are struggling with SUDs or mental health. Whether you are a veteran experiencing SUD or mental health issues, working with veterans, or simply a  community member invested in the rehabilitation process, learning more about VTCs can be an important first step in supporting the vital work they do. The REDI recognizes the importance of uplifting VTCs and their participants, and is committed to improving VTC programming by identifying and helping to eliminate instances of RED.

Be sure to check out the REDI’s website to learn more about the RED Program Assessment Tool and our mission.