Serving those Who Served: Outcomes from the San Diego Veterans Treatment Review Calendar (SDVTRC) Pilot Program

Abstract

Veterans Treatment Courts (VTCs) are a type of specialty treatment, problem-solving, criminal court. Though the number of VTCs has increased over the past decade, few research studies have examined their effectiveness. This paper examines the data collected concerning a particular VTC experience, the first 82 Veterans enrolled in the Veterans Treatment Review Calendar Pilot Program conducted by the California Superior Court of the county of San Diego from February 2011 until July 2014 (SDVTRC.) The evidence presented herein concerns the nature of this cohort’s population, the SDVTRC program structure in which these Veterans participated, and the outcomes of participation. SDVTRC participants showed a significant decrease in symptoms on 11 of 12 clinical measures from baseline to 12 months. Particular outcomes of the SDVTRC program were related to factors of military service, such as length of service, number of awards, and discharge status. There were also significant relationships between symptom decrease and court process factors, such as length of time in program and sanctions imparted. This court has a 0% recidivism rate, which is believed to be related to its systematic data collection process that was used to inform individualized treatment plans for participants. Implications for other VTCs are provided.

Appendices

Appendix 1 CA Penal Code §1170.9

CA Penal Code §1170.9 was the statutory basis for the SDVTRC Pilot Program. That law allows a judge to sentence an eligible veteran to court monitored treatment in lieu of incarceration if certain findings are made. To admit a veteran to SDVTRC, the Judge had to find:

• 1. the defendant was, or currently is, a member of the United States military; and

• 2. the defendant is suffering from sexual trauma, traumatic brain injury, post-traumatic stress disorder, substance abuse, or mental health problems as a result of that service; and

• 3. the criminal conduct is related to that mental health condition.

The statute allows that the court may request, through existing resources, an assessment to aid in that determination. The process was that the defendant presented evidence that he/she was eligible for admission. The SDVTRC Team evaluated the evidence and made a collective recommendation to the judge regarding eligibility and the proposed treatment plan for the defendant. No team member possessed veto power over any admission.

Appendix 2 SDVTRC Participant’s Handbook

Phase I – Goal: Demonstrating Accountability

Lasts minimum of 4 months and maximum of 8 months

During Phase I, you will sign all entry documents and begin the most intensive part of your treatment plan therapy. You will make contact with your mentor and begin to share about your life and recovery. You will get to know the SDVTRC Team and Judge while they also get to know you. You will develop a dedication to taking care of the things you are assigned to do. You will learn how to approach any problems that arise while using the resources of the treatment program and SDVTRC program available to help you with them. You will be required to make all treatment appointments and court appearances and be on time and prepared for them.

Phase I will usually include these components:

1.Satisfactory progress in your designated treatment program including a minimum of two hours of individual or group therapy sessions weekly that directly address your assessed condition.

2.Chemical testing on a random basis and/or alcohol monitoring if assigned.

3.Taking medication as directed by medical and mental health professionals.

4.Attendance at Veterans recovery support/self-help meetings if assigned (a minimum of one per week).

5.Actively keeping contact and engaging in discussions and activities with your SDVTRC mentor.

6. Reporting to your Probation Officer as directed (formal probation only).

7. Any additional case management services as determined by you and the treatment team. (For example, 12 step program meetings; domestic violence counseling; vocational or educational counseling; family counseling; specialized psychotherapy; nutrition or weight loss; exercise; anger management, parenting skills, etc.)

8. Bi-weekly or monthly court appearances as determined by the Judge.

9. Curfew as directed by the Court, probation or treatment team.

Advancement Criteria

In order to advance to Phase II, you must ask to be advanced. Your request will need to be written and honestly address what you have learned in the SDVTRC program thus far, and why you feel you have earned advancement. The SDVTRC team will then address the specific items below to make sure you have done them and then recommend your advancement to the SDVTRC Judge. The SDVTRC Judge will decide if you will be advanced. The SDVTRC Team and Judge will review your progress to date and your written request in making their recommendation or decision. Your request may be read by you to the SDVTRC Judge in court. Specific items you must demonstrate in order to advance are as follows:

• Completion of the most intense portion of your counseling and therapy program (as directed);

• Be in full compliance with all terms and conditions of your probation;

• Work with your treatment providers to set your personal goals and activities plan for Phase II;

• Demonstrate awareness of how your response to your traumatic condition led to your criminal activity;

• Demonstrate mastery of the tools you can use to prevent future crime;

• Have no positive chemical test results (including missed, tampered or dilute tests) for 90 consecutive days;

• Have no unexcused absences from scheduled services for 21 consecutive days

• Demonstrate you have used medication as directed by your medical staff for a minimum of 60 days.

• Documentation of required minimum attendance at recovery support/self- help meetings for a minimum of 90 days.

• Complete and return monthly symptom checklists consistently;

• Have the endorsement of the SDVTRC team.

• Have your request granted by the SDVTRC Judge.

Phase II – Goal: Demonstrating Responsibility

Lasts minimum of 4 months and maximum of 8 months

During Phase II, you will focus on completing the structured part of your treatment plan and prepare yourself for independent recovery. If you are in a residential program, the program will begin to prepare you to leave by assisting you in increasing your coping skills, building job skills or income sustainability, seeking information about college or vocational training, and obtaining a stable living environment. If you are in a non- residential program, these goals will be addressed by working with your case manager and mentor. The most intense part of therapy will end, and therapy sessions will happen less frequently or cease. You will continue to make regular contact with your mentor and share about your life and recovery. You will know the SDVTRC Team and Judge and they will know you. You will demonstrate that you are responsible by taking care of the things you are assigned to do without reminders or missed appointments or meetings.

Additionally, you will devise a “Give Back” project in consultation with your treatment provider and SDVTRC Team that will give back to the community in a meaningful way. The purpose of this project is to reconnect you with the community in a positive and helpful manner. Work at non-profits (designated under IRS Code §501(c)3), speaking or writing engagements, teaching youth, using your military skills to improve the non-profit’s facilities are all examples, but are not the only ways to do a Give Back project. You should think in terms of your leading role in the project rather than merely joining others in an already organized activity. This project should be individually planned by you, demonstrate a significant accomplishment; emphasize your strengths, show creativity and personal initiative to make a contribution to your community. Give Back project planning should begin on your first day of Phase II and should be discussed in the planning stage with your treatment providers and mentor. It must be presented in writing to the SDVTRC team for approval at team staffing at least two weeks prior to when it will be accomplished.

Your confidence in your ability to handle common problems will grow in Phase II and minor challenges will not overwhelm you. You will reach out to other participants and offer your experience, strength and encouragement to help them. You will continue to be on time for appointments, court appearances and be prepared for them.

Phase II will usually include these components:

• 1. Satisfactory progress in your designated treatment program including individual or group therapy sessions that directly address your assessed condition.

• 2. Completion of your residential treatment program and transition to independent living arrangement.

• 3. Substantially complete your therapeutic and personal goals and activities plan;

• 4. Chemical testing on a random basis and/or alcohol monitoring (if assigned).

• 5. Demonstrating initiative by proposing, obtaining SDVTRC Team approval and completing your “Give Back” project.

• 6. Taking medication as directed by medical and mental health professionals.

• 7. Attendance at Veterans recovery support/self-help meetings (a minimum of one per week as directed).

• 8. Actively keeping contact and engaging in discussions and activities with your SDVTRC mentor.

• 9. Reporting to your Probation Officer (as directed).

• 10. Progress on any additional case management services and court required programs as determined by you and the SDVTRC team/judge. (For example, 12 step program meetings; domestic violence counseling; vocational or educational counseling; family counseling; specialized psychotherapy; nutrition or weight loss; DUI courses; exercise; anger management, parenting skills, etc.)

• 11. Bi-weekly or monthly court appearances as determined by the Judge.

• 12. Curfew as directed by the Court, probation or SDVTRC team.

Advancement Criteria

In order to advance to Phase III, you must ask to be advanced. Your request will need to be written and honestly address what you have learned in the SDVTRC program thus far, and why you feel you have earned advancement. The SDVTRC team will then address the specific items below to make sure you have done them and then recommend your advancement to the SDVTRC Judge. The SDVTRC Judge will decide if you will be advanced. The SDVTRC Team and Judge will review your progress to date and your written request in making their recommendation or decision. Your request may be read by you to the SDVTRC Judge in court. Specific items you must demonstrate in order to advance are as follows:

• Progress in learning coping skills and useful tools in your counseling and therapy program;

• Be in full compliance with all terms and conditions of your probation;

• Work with your Case Manager or treatment provider to create your personal goals and activities plan for Phase III;

• Demonstrate understanding of how your trauma condition can hurt you, your family, and the community;

  • Completion of your pre-approved “Give Back” project;

• Demonstrate mastery of the tools and coping skills you can use to prevent future crime in yourself and others in the SDVTRC program;

• Have no positive chemical test results (including missed, tampered or dilute tests) for 120 consecutive days;

• Have no unexcused absences from scheduled services for 60 consecutive days;

• Demonstrate you have used medication as directed by your medical staff for a minimum of 120 days.

• Documentation of required minimum attendance at recovery support/self- help meetings for a minimum of 32 meetings.

• Complete and return monthly symptom checklists consistently;

• Have the endorsement of the SDVTRC team.

• Have your request granted by the SDVTRC Judge.

Phase III – Goal: Demonstrating Independence and Productivity

Lasts minimum of 4 months and maximum of 8 months

During Phase III, the last phase of the SDVTRC program, you will focus on completing your treatment plan and move toward being an independent and productive citizen. You will have a support system in place to help you and skills/tools that you can use to manage your traumatic condition and be a survivor. You will be crime free and maintain stable housing, employment or school. You will initiate contacts with your mentor as needed and develop other supportive and healthy relationships. You will make greater contributions in serving your fellow veterans and the community. The SDVTRC Team and Judge will encourage and support you as you move toward your own plan for life goals and activities. You will demonstrate that you are a responsible leader by helping others in recovery from traumatic conditions. Your confidence in your ability to handle common problems will be evident even when challenges arise. You will continue to be on time for appointments, court appearances and be prepared for them.

Phase III will usually include these components:

• 1. Substantial completion of any remaining court requirements.

• 2. Maintain an independent living arrangement for 60 consecutive days.

• 3. Substantial completion of your personal goals and activities plan;

• 4. Chemical testing on a random basis and/or alcohol monitoring as directed.

• 5. Being a leader by demonstrating your assistance to other veterans with traumatic conditions.

• 6. Taking medication as directed by medical and mental health professionals.

• 7. Leadership in Veterans recovery support/self-help meetings (as directed).

• 8. Actively initiating contact and engaging in discussions and activities with your SDVTRC mentor.

• 9. Actively developing support relationships to support you when the court releases you from the SDVTRC program.

• 10. Reporting to your Probation Officer as directed.

• 11. Complete any outstanding case management services as determined by you and the treatment team/judge and substantially complete all court requirements. (For example, 12 step program meetings; domestic violence counseling; vocational or educational counseling; family counseling; specialized psychotherapy; nutrition or weight loss; exercise; anger management, parenting skills, etc.)

• 12. Monthly court appearances or less often if determined by the Judge.

• 13. Curfew as directed by the Court, probation or SDVTRC team.

Advancement Criteria

In order to graduate from the SDVTRC Program you must ask to be recognized for graduation. Your request will need to be written and honestly address what you have learned in the SDVTRC program thus far, and why you feel you have earned graduation. The SDVTRC team will then address the specific items below to make sure you have done them and then recommend your graduation to the SDVTRC Judge. The SDVTRC Judge will decide if you will graduate. The SDVTRC Team and Judge will review your progress to date and your written request in making their recommendation or decision. Your request may be read by you to the SDVTRC Judge in court. Specific items you must include in your request and demonstrate in order to graduate are as follows:

• Cite specific examples that show you can use the coping skills and useful tools you have learned in your counseling and therapy program;

• Confirmation that you are in full compliance with all terms and conditions of your probation;

• Demonstrate independent living, employment or full-time school, and that you make a productive use of your time by engaging in positive, chemical- free social activities;

• With help from your treatment provider and mentor, write your plan for aftercare for the next two years including counseling; relapse plans; ways you will connect positively with sponsors and significant others; support group meetings; and hobbies/training.

• State your new personal goals and activities plan for the next few years of your life;

• Demonstrate remorse for your crimes, make amends to your crime victims, and a dedication to remain law abiding;

• Make a commitment to help someone else in recovery;

• Have no positive chemical test results (including missed, tampered or dilute tests) for 180 consecutive days;

• Have no unexcused absences from scheduled services for 90 consecutive days;

• Demonstrate you have used medication as directed by your medical staff for a minimum of 180 days.

• Documentation of required minimum attendance at recovery support/self- help meetings for a minimum of 50 meetings.

• Complete and return monthly symptom checklist consistently.

• Have the endorsement of the SDVTRC team.

• Have your request granted by the SDVTRC Judge.