The King County Family Treatment Court: What is it? What Have We Learned from our Evaluation?

11

Eric BrunsMike Pullmann Ericka Wiggins

University of Washington School of MedicineDivision of Public Behavioral Health and Justice Policy

www.uwhelpingfamilies.org

Jill MurphyAubrey Glines

King County Family Treatment CourtKing County Superior Court

University of WashingtonEducation Series for Child Welfare Professionals

April 11, 2012

The King County Family Treatment Court:What is it? What Have We Learned from our Evaluation?

Substance Abuse and Child Welfare

• 80% of children in foster care have a parent with a substance abuse problem– Parents with substance problems have the

lowest rate of reunification with their children– Their children stay in foster care over twice as

long on average

• Initiation of treatment takes an average of 4-6 months after entry to CW system

2

The need for a solution

• Treatment completion is associated with:– Less time in foster care– Reunification rates

• More rapid treatment entry and longer treatment duration is associated with:– Treatment completion– Treatment success– Less time in foster care– Reunification rates

3

Drug Courts

• Interdisciplinary, coordinated, team-based approach to avoiding future involvement in (criminal) justice system

• As of 2010: 2,459 drug courts in U.S.– Number increased by 50% from 2004 – 2010

• Seven meta-analyses– Rigor of studies often lacking; however, positive

effects found• Positive treatment outcomes• Reduced re-arrest

4

Family Treatment Drug Courts

• Apply drug court approach to cases of child abuse and neglect

• Goal = enhance possibility of family reunification within legal timeframes by:– Facilitating entry and completion of treatment– Supporting parent to remain abstinent– Improving child safety/family functioning

• As of 2009, NADCP reports 322 FTDCs– 13% of all drug courts in U.S.– Increase of 66% from 2005

5

Today’s presentation

• The King County Family Treatment Court– Goals– Population of focus– Program description– Case flow process

• What we have learned from an evaluation– Process evaluation – Outcome evaluation

6

The King County Family Treatment Court

Jill Murphy

KCFTC Program Supervisor

Aubrey Glines

KCFTC Graduate

7

KCTV Video

• http://youtu.be/XU1gSDyTBxw

8

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King County FTC Primary Goals• Children have safe and permanent homes within

permanency planning guidelines;• Families of color have outcomes from

dependency cases similar to families not of color;

• Parents are better able to care for themselves and their children and seek resources to do so; and

• The cost to society of dependency cases involving substances is reduced.

9

1010

KCFTC PROCESSES AND FUNCTIONS•Comprehensive SB Assessment•High quality, appropriate CD Services•Timely/effective MH and other services•Effective care planning and management•Expanded and more frequent visitation•Consistent, timely incentives & sanctions•Random UA Screens•Effective pre-hearing case conferences•Effective judicial interaction

SHORT-TERM OUTCOMES•Eligibility/enrollment completed quickly•Enrollment in appropriate CD services•Parents compliant with/complete treatment•Parents ultimately able to remain sober•Parents/children more fully engaged in svcs•Parents/children receive needed services•Decreased placement disruptions•Parents compliant with court orders•Less negative effect on child well-being•Less disruption of child-parent bonds•Increased family reunification rates•Earlier determination. of alternate placement options

NATIONAL BEST PRACTICES•Communication bw Court and providers•Judge plays active role in Tx process•Judge responds to positive & noncompliant beh.•Mechanisms for shared decision making•Accountability for Tx services•Strategy for responding to noncompliance•MIS allow data to be assembled/reviewed•Enhancement of due process•Team members provided adeq resources

The King County Family Treatment Court

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Population Focus

Up to 60 children at a time, whose parent(s):• Admit to the court that his/her child is dependent or have

an existing dependency finding• Are chemically dependent and willing to go to treatment;• Are at least 18 years of age;• Sign a Consent to Release Confidential Information

Form so that the team may share information with other team members and outside community providers;

• Have no felony child abuse or sexual abuse guilty findings; and

• Applications/referrals to FTC must be received no later than six months from the date of dependency petition.

12

KCFTC Program Model• Parents agree to enter a more intensive court process

– Expectation = 12 mos – 2 years duration• Case management to ensure connection to appropriate

chemical dependency treatment• Cross-disciplinary pre-hearing staffings to present a

unified approach at hearings• Case review hearings every other week until frequency

can be stepped down• Treatment Liaison who monitors parent’s progress in CD

and MH treatment and provides case management• Formal Wraparound Process for approx 1/3 of families

(15 at a time)• Social Workers dedicated to the FTC with reduced

caseloads (12:1)

13

KCFTC Team Members

• Judge• Assistant Attorney

General• Parent’s Defense

Attorney• Child’s Attorney• Treatment specialist/

Treatment liaison• Treatment provider

• Court Appointed Special Advocate (CASA)

• Wraparound coordinator• DCFS Social Workers• FTC Program Supervisor• FTC Program Court

Specialist• Family members/friends• Family support providers

1414

Placement in Shelter Care

Dependency Petition Filed

Shelter Care Hearing(w/in 72 hours of place-ment or filing, whichever

occurs first)

Pre-TrialConference(21 days prior to

fact-finding)

Fact-Finding Hearing

(w/in 75 daysof filing)

Disposition Hearing

(same day as or w/in 14 days of dep finding)

Review Hearing(the sooner of 90 days from Dispo. or 6 mos.

from date of placement)

Permanency Planning Hearing(12 months from date of placement & every 12

months thereafter)

Review Hearing(w/in 6 months after

permanency planning hearing)

PetitionApproved

DependencyContinued

Exit System

Yes

PermanencyGoal Achieved?

Yes

PermanencyGoal Achieved?

Petition forParental Rights Termination?

No

No

Petition forParental Rights Termination?

No

No

Petition for Termination of Parental Rights

Filed

Yes

Yes

PetitionDismissed

PetitionDismissed

PetitionDismissed

PetitionDismissed

30-Day Shelter Care Review(w/in 30 days of

placement)

Shelter Care Case Conf.(30 days prior to

fact-finding)

PetitionDismissed

Dept. supervision

continues for 6 mos.

Childreturned

home

Review Hearing

PetitionDismissed

Dependency Stipulated

Enter FTC*(See separate

flow chart)

Enter FTC*(See separate

flow chart)

Exit FTC w/o Permanency Goal Achieved

Exit FTC w/o Permanency Goal Achieved

Original Chart prepared by Michael Curtis on January 12,

2006

*There can be entry into FTC anytime after dependency is established as long as a referral is made to FTC within 6 months of the filed petition date.

*There can be entry into FTC anytime after dependency is established as long as a referral is made to FTC within 6 months of the filed petition date.

Juvenile Dependency Case Flow (noting FTC)

1515

FAMILY TREATMENT COURT CASE PROCESSING FLOW CHART

Check In Hearing: Set for following week after positive/missed UA or noncompliance w/ tx

Compliance Clock Hearing: Can be applied

after 5th response and set 60 days out from

current hearing

Motion Hearing: Can be set anytime there is a contested issue. Not

heard during regular FTC calendar

Discharge/Opt Out Hearing: Dependency

dismissed or discharged

to regular dependency

Other FTC Hearings:

Box Color Legend:

Red: Not a hearing

Green: Beginning and end of FTC Process

Blue: FTC Review Hearings

Graduated Blue: Does not occur on every case

Orange: Not unique to FTC

Purple: Unique to FTC and can occur throughout FTC process

16

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Evaluation of the King County Family Treatment Court

Division of Public Behavioral Health and Justice Policy

University of Washington School of Medicine

UWHelpingFamilies.org

18

Needs for the Evaluation

• Provide information needed by the KCFTC and its stakeholders

• Expand the research base on FTDCs– Do FTDCs achieve their stated goals and outcomes?– Do they contribute positively to federal priorities for

CW systems?– Do common criticisms of drug courts apply to FTDCs?

• Widening the net of involvement in justice system• Mandate longer involvement in justice system• Limit access to or completion of treatments• Not cost effective

19

20

Summary of the FTDC Literature• Four studies of FTC model (Boles et al., 2007; Edwards et al.,

2005; Green et al., 2007, 2009; Worcel et al., 2008;)• All four studies show positive outcomes:

– Parents enrolled in treatment more quickly– Parents received treatment services for a longer mean duration– Parents were more likely to successfully complete treatment– Children placed in permanent living situations more quickly– Children more likely to be reunified (e.g., 42% vs. 27% at 2

years; 70% vs. 45% at 3-4 years)• No study found between-group differences in future abuse/neglect

reports

21

Summary of the FTDC Literature• NPC Research, the most active evaluators of

FTCs and drug treatment courts, has completed several cost-benefit analyses at sites across the nation. The table below summarizes their findings:

Location Cost savings per participant

Return on investment

Areas of savings

Harford Co., MD

$12,000 over 1 year

350% Foster care days, Criminal justice, Court Cases

Jackson Co., OR

$5,593 over 4 years

106% Foster care days, Probation/Parole, Court Cases

CA "Court 1" $1,657 over 4 years

130% Not provided

CA "Court 2" $2,141 over 5 years

Not provided

Not provided

Baltimore, MD

$5,022 over 1 year

Not provided

Foster care days (did not examine other areas)

2222

Components of the KCFTC Evaluation

• Process evaluation– Interviews with team members and

stakeholders, 2006 and 2008– Parent interviews, 2007-2009

• Outcomes evaluation– Analysis of child placement data from Children’s

Administration and adult treatment data from the Division of Behavioral Health and Recovery

• Cost-benefit analysis– Currently underway

Respondent Type N % N %

Advisory Group Member 8 21% 5 14%

DSHS Social Worker/Social Worker Supervisor 5 13% 5 14%

Court Appointed Special Advocate (CASA)/CASA Manager or Supervisor

7 18% 4 11%

Attorney (Parent or Child) 6 15% 6 16%

Judge 2 5% 3 8%

UW PCAP Representative 2 5% 1 3%

AAG /AAG Supervisor 1 3% 2 5%

Treatment Provider/Treatment Provider Superv. 4 10% 3 8%

FTC Coordinators/Specialists 2 5% 3 8%

Wraparound staff/supervisors 2 5% 1 3%

Other (e.g., Bailiff, Alumni) 1 3% 4 11%

2006 (n=39) 2008 (n=37)

Respondents

0%

10%

20%

30%

40%

50%

60%

70%

Overall Success of Accomplishing Goals"How successful do you feel the court has been in accomplishing its goals

overall?" 2006-2008 (n=38, 37)

2006 3% 3% 53% 34% 8%

2008 0% 5% 24% 62% 8%

Not at all successful

A little bit successful

Somewhat successful

Moderately successful

Extremely successful

2006: Mean= 3.4 Std. Dev= .793

2008: Mean= 3.73 Std. Dev= .693

0%

5%

10%

15%

20%

25%

30%

35%

40%

Overall Success compared to regular dependency court"Compared to the regular dependency court process, how succesful do you

think KCFTC is in accomplishing these overall goals for participating families?"

2006-2008 (n=37, 36)

2006 0% 5% 11% 19% 27% 24% 14%

2008 0% 3% 11% 6% 19% 39% 22%

Much less successful

Somewhat less

successful

About the same

A little bit more

successful

Somewhat more

successful

A good deal more successful

Much more

successful

2006: Mean= 5 Std. Dev= 1.4

2008: Mean= 5.47 Std. Dev= 1.36

Summary of Major QuestionsMeans

0

0.5

1

1.5

2

2.5

3

3.5

4

2006 3.4 3.3 2.7 2.94 3.45 3.53

2008 3.73 3.95 3.93 2.56 3.83 3.94

Overall successServing target population

Serving Representative

population

Referral and Eligibility

FTC Collaboration

FTC Shared Vision

Summary of Process and Function Questions

Means

2 2.5 3 3.5 4 4.5 5

Effective judicial interaction

Training and education for FTC staff

Effective pre-hearing case conferences

Random UA screens

Consistent, timely incentives and sanctions

Expanded and more frequent visitation

Care planning and management

Timely/ effective other services (children)

Timely/ effective other services (parents)

High quality, appropriate CD services

Comprehensive SB Assessment

2006

2008

A little bit

successful

Somewhat

Successful

Moderately

successful

Extremely

successful

2828

What we learned from process evaluation

• Strengths– Strong opinions about the positive impact of KCFTC– Most processes and functions viewed as successfully being

accomplished by 2008• Relative Weaknesses

– Respondents less confident that goal of serving a representative population was being met

– Respondents believed client load was less than optimal (serving too few families)

– Mixed opinions on the amount of shared vision among team members

– Certain processes and functions:• Efficiency of eligibility determination and intake• Consistency and effectiveness of incentives and sanctions• Resources and training for KCFTC staff and team members

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Outcome Evaluation:Research Question 1

• When compared to comparable non-FTDC participants, do FTDC participants differ in terms of their experience with the court and treatment system?

• Hypotheses – FTDC participants would:– Have more court hearings; – Enter treatment more often;– Enter treatment more quickly;– Attend treatment sessions more consistently;– Receive more treatment events;– Receive a broader treatment array;– Remain in treatment longer; and– Successfully discharge from treatment more often.

Research Question 2

• When compared to children of non-FTDC participants, do children of FTDC participants demonstrate more positive child welfare outcomes?

• Hypotheses – KCFTC children would:– Spend less time in out-of-home placements;– Reunify with their parents more often;– Get placed in permanent living situations more quickly;

and– Have fewer subsequent child welfare investigations and

founded investigations30

Research Question 3

• Do families of color have outcomes similar to families not of color?– Treatment outcomes– Child welfare outcomes

31

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Outcome Evaluation• Administrative data:

– Treatment data from Division of Behavioral Health and Recovery – Child welfare data from Children’s Administration– Hearing data from King County Superior Court– Data collected September 2010

• Family Treatment Court group:– Selected all parents admitted to the FTC between March 2006

and October 2009

• Comparison group:– Eligible parents referred but not admitted to the Family

Treatment Court– Randomly selected a reasonable number– Statistically matched (propensity score methods) on caregiver

age and race, number of prior child welfare investigations, whether parent was in treatment at petition, number of prior treatment episodes, and primary drug of choice

33

Reasons why parent is in comparison group

Percent

Attorney not responding 42%

Over 6 months without referral 18%

Chose not to participate 8%

No known address/can’t locate/on run 7%

Other 8%

Reason missing 17%

34

44%

1%

6%

1%3%

1%

7%

1%

14%

23%

56%

15%

40%

59%

18%

Parentwhite

Parent ofcolor

AfricanAmerican

AmericanIndian

Asian Hispanic PacificIslander

Missing

Comparison

FTC

Parent mean age• Comparison = 31• KCFTC = 31

Mean # of children per participant• Comparison=1.39• KCFTC = 1.46

Detail: specific race/ethnicity

Total # of parents = 268• Comparison = 182• KCFTC = 76

Parent demographics

Note: no significant differences

35

Prior Investigations

Comparison %or Mean (SD)

KCFTC %or Mean (SD)

Any investigation completed prior to petition 83% 79%

Type of Allegation (index petition)

Neglect 83% 77%

Abuse 36% 36%

Prenatal Injury 8% 9%

Medical Neglect 8% 7%

Abandonment 2% 3%

Number of investigations prior to petition 2.1 (2.1) 1.8 (2.3)

Note: No statistically significant differences

36

50%

4%

10%

2%

26%

6%

1%

17%

50%

35%32%

38%

54%

46%

28%

Female Male White AfricanAmerican

Asian/PI NativeAmerican

Hispanic Unknown

Comparison

FTC

Child Mean Age• Comparison = 4.2• KCFTC = 3.5

Number of children• Comparison = 235• KCFTC = 89

Child demographics

Note: Statistically significant difference for Native American

3737

Status of FTC parent at time of data collection

FTC(n=76)

Discharged 33%

Graduated 26%

Currently enrolled 22%

Opted out of program 11%

Certificate of participation 7%

Dismissed 1%

38

Note on Analytic Approach…• 1). “Intent to treat”

– All parents who were admitted to FTC were included in all analyses, even if they opted out or had an unsuccessful outcome.

• No parent who was ever in FTC was ever included in the comparison group

• 2). Index Petition Date– “Time Zero” or comparable start point for both groups

was the petition date, not date of entry into FTC (comparison group had no date of entry)

These decisions likely result in more conservative findings

39

• Question 1: Do FTC participants have different treatment and court experiences than comparable non-FTC parents?– Do they experience more court hearings?– Are they more likely to enter treatment?– Do they enter treatment more quickly?– Are they more likely to attend treatment?– Do they remain in treatment longer?– Are they more likely to be successfully

discharged from treatment?

FTC parents have more court hearings

• 11 months post petition (mean follow up time for overall sample):– FTC: mean 16.1 (SD = 4.8) hearings– Comp: 5.9 (2.4)

– (p<.001)

• Review hearings were 4.5 times more frequent for FTC (accounted for 75% of all FTC hearings)

40

41

FTC parents are more likely to enter treatment

40%

20%

53% 52%59%

32%

88%84%

Admittedprior topetition

In treatmentat petition

Admittedafter

petition

Received txafter

petition

Comparison

FTC

Note: All differences statistically significant

FTC parents were 63% more likely to be admitted to treatment.

42

FTC parents enter treatment three times as fast

Of those parents entering treatment who were not already in treatment at the index petition, the median days until treatment entry were:

• Comparison: 120

• KCFTC: 36

Note: Statistically significant difference, p < .001

Pro

por

tion

not

adm

itted

43

FTC parents received broader service array

Of those admitted to any treatment

Comparison(n=52)

KCFTC(n=68)

Long term Residential* 46% 65%

Intensive Outpatient 40% 56%

Outpatient 50% 50%

Intensive Inpatient 44% 35%

Methadone 23% 27%

Recovery House* 2% 9%

Housing Support 8% 3%

* Statistically significant difference, p < .05

44

FTC parents received broader service array

Of those who received any treatment

Comparison(n=44)

KCFTC(n=64)

Individual therapy* 89% 100%

Group therapy 90% 97%

Case management 81% 89%

Urinalysis 43% 52%

Methadone/opiate subst. 15% 25%

Childcare* 11% 25%

* Statistically significant difference, p < .05

45

FTC parents received more treatment but were not

significantly more likely to attend treatment

Comparisonn=6,188

FTCn=8,357

Attended treatment episode 88% 90%

Excused by provider 6% 4%

No show, unexcused 8% 6%

Note: Statistically significant difference, p < .05

Avg. # of treatment events per person who received treatment:

• KCFTC = 116 (SD=97)

• Comparison = 51 (SD=57)

Note: Not statistically significant difference, p =.40

46

FTC parents remain in treatment longer

(Of those entering treatment; N=110)

Of those parents who entered treatment, the median days in treatment were:

• Comparison: 44

• FTC: 109

Note: Statistically significant difference at beginning and

middle, p < .05

47

Success in treatment

• FTC parents remained in treatment twice as long (median of 109 days compared to 44)

• FTC parents 37% more likely to be successfully discharged from treatment (72% compared to 54%)

Note: Statistically significant differences, p < .05

48

• Question 2: Do FTC families, compared to similar families who did not receive FTC services, have more positive child welfare outcomes? Specifically:– Do the children of FTC participants spend less time in

out of home placement?– Are the children of FTC participants placed in

permanent living situations more quickly overall?– Are FTC children more likely to have a permanent

placement?– Are FTC participants less likely to have subsequent

CPS investigations?

49

FTC children spend less time in out-of-home placements

Note: Statistically significant difference, p < .05

Median days in out of home placement:

• Comparison: 689

• FTC: 476

50

FTC children end involvement with the child welfare system more quickly

Note: Statistically significant difference, p < .05

Median days until permanent placement:

• Comparison: 813

• FTC: 718

51

Child Welfare OutcomesAt end of study window

• FTC children spent 30% less time in out-of-home placements– median of 476 days, compared to 689

• FTC children spent 20% less time in the child welfare system– median of 718 days, compared to 813

• FTC children 43% more likely to have a permanent placement– 61% compared to 43%

Note: Statistically significant differences, p < .05

52

Placement types/ReunificationAt end of study window

• FTC children 2.5 times more likely to return to the custody of their parent (27% compared to 11%)

• FTC children half as likely to be in an out of home placement (24% compared to 46%)

• FTC children 1.9 times more likely to be returned home (in parental custody, reunified, trial home visit; 55% compared to 29%)

Note: Statistically significant differences, p < .05

53

Subsequent child welfare investigations: All parents

At end of study window

Note: Not statistically significant difference

54

Subsequent child welfare investigations: Only parents with child returned home

At end of study window

p=.09 p=.13

55

Subsequent child welfare investigations: All children

At end of study window

Note: Not statistically significant difference

56

Subsequent child welfare investigations: Only children who returned home

At end of study window

Subsequent removals: 3% for FTC group (n=1) vs. 13% for Comparison (n=3); p=.13

Findings similar to other FTDC studies

57

    Current Study

Ashford, 20041

Boles et al., 2007

Green et al., 2007

Worcel et al., 2008

Burrus et al., 2011

% Enrolled in treatment

FTDCComp.

84%57%

97%67%

56%2

56%2

89%69%

82%59%

Mean days until treatment entry

FTDCComp.

6399

    73182

84122

5788

Mean days in first treatment

FTDCComp.

14296

  893

1143

303184

306148

13882

% completed treatment

FTDCComp.

72%54%

48%31%

64%2

64%2

44%34%

65%33%

64%36%

% children reaching permanency

FTDCComp.

61%43%

    57%44%

  35%38%

Mean days until permanency

FTDCComp.

475502

251341

  359435

288228

249325

% children reunified

FTDCComp.

55%29%

52%36%

42%27%

43%32%

69%39%

70%35%

Subsequent founded investigation4

FTDCComp.

28%29%

    23%15%

Subsequent removal from home5

FTDCComp.

3%13%

46%50%

11%23%

58

Question 3: Do families of color have outcomes similar to families

not of color?

59

Question 3: Do families of color have outcomes similar to families

not of color?

6060

52%

87%

56%

90%

Comparison FTC

Parent white

Parent white

Parent of

color

Parent of

color

Parents of color did not differ from white parents in their likelihood to:

• Be in treatment when petition was filed

• Be admitted to treatment after petition

• Schedule treatment episode after petition is filed

Note: No statistically significant differences

Admitted to treatment through DBHR after petition

All parents

6161

Note: White-white, p < .05

POC-POC, p < .10

81

5149

152

Comparison FTC

Parent white

Parent of color

Parent white

Parent of color

Median days until treatment entry

Of those not in treatment at petition

6262

Median days in first treatment

Note: White-white, p < .05

POC-POC, p < .10

FTC: POC-White mixed

43

77

151

53

Comparison FTC

Parent white Parent

of color

Parent white

Parent of color

6363

Length of time in first treatment episode

Of those parents entering treatment, the median days in first treatment episode:

• Comparison, parent of color: 43

• Comparison, white: 53

• KCFTC, parent of color: 77

• KCFTC, white: 151

Note: No statistically significant differences

6464

Percentage successfully completing a treatment episode

Of those receiving treatment

Note: POC-POC p < .05

No other significant differences

52%

68%

55%

82%

Comparison FTC

Parent white

Parent white

Parent of

color

Parent of

color

6565

Percentage of children with permanent placements

Note:

All: Comp-FTC p < .05

No other significant differences

45%

66%

41%

57%

Comparison FTC

Child white

Child of color

Child white

Child of color

6666

Percentage of children remaining in out of home placement

Note:

All: Comp-FTC p < .05

FTC: COC – Child white, p < .10

No other significant differences

45%

11%

47%

28%

Comparison FTC

Child white

Child of color

Child white

Child of color

67

Comparing FTC to regular court for families of color

• Generally indicate that families of color in FTC had more positive outcomes than families of color in the comparison group– 61% more likely to enter treatment– Enter treatment 63% faster– Remain in treatment nearly twice as long– 49% more likely to complete treatment– Children 39% more likely to be permanently placed– Children 54% more likely to be returned home

68

Comparisons by race in FTC

• Parents of color in the FTC were not significantly different than white parents on:– Percentage admitted to treatment– Speed of admission to treatment– Percentage successfully completing treatment

• Parents of color spent less time than white parents in treatment

• Children of color might be more likely to remain in out-of-home placements (borderline significance)

69

Outcome Study Summary• The King County Family Treatment Court is one of a

variety of problem-solving courts• Staff from several disciplines and agencies collaborate

on supervision and support• Stakeholders generally have positive opinions about the

development and functioning of the court• Parents have more successful substance use treatment

outcomes• Children are more likely to exit the child welfare system

and be returned to the care of their parents• Other research with similar findings to our research also

found significant long-term cost savings

Internal vs. External costs and benefits

Overall costs/benefits to society

County government

State government

Federal government

Participants

Child Welfare DSHS (treatment)

Citizens and communities

Family Treatment

Court

• External benefits underproduction of the service (i.e. too little Family Treatment Court)

• External costs overproduction of the service

71

Child Welfare

Placements

Caseworker time

Caregiver-child visitations

Substance Use and Mental Health treatment

DSHS-provided treatment services

Private pay or insurance treatment services

Justice System

Dependency court hearings

Adult contacts with law: prison, jail, criminal hearings, probation, etc.

Child contacts with law: prison, jail, criminal hearings, probation, etc.

Damages to victims

Non-monetary costs

Emotional pain from loss of child/parent

Broken communities

Emotional pain to victims

Others

Employment

Education

Physical health care

Public assistance

Costs and Benefits

72

Please contact us with any questions

Eric [email protected] Pullmann

[email protected]

Mark [email protected]

Jill [email protected]