Programs to integrate substance abuse treatment with pretrial
case processing cost money to run. Funding must be found to
pay for the costs of treatment, ancillary services, and all the
other treatment, justice system, and public health functions.
This chapter focuses on identification of program costs and
strategies for meeting those costs.
The costs of a program can be broken down into its component
parts. Since programs will vary widely depending on the size
and composition of the target group, the point(s) in the court
process at which program intervention occurs, the types of treatment
services provided, and a myriad of other factors, the costs will
vary widely from jurisdiction to jurisdiction. The following
is a preliminary list of possible costs:
Treatment and ancillary services costs. These are
the costs of all of the treatment and treatment-related services
provided by the program. Depending on the scope of the program
and size of the target population, they could include any or
all of the following:
Substance abuse screening
Detoxification facility and services
Substance abuse assessment and treatment planning services
Counseling therapy (group, individual, family)
Medical assessment and treatment services
Mental health services
Drug testing equipment and lab services
Child care
Case management and court liaison services
Computers and software
Job training and counseling
Special costs associated with inpatient or residential treatment,
if used
Social service support such as assistance in obtaining housing,
food and medical care
Aftercare services
Justice system costs. When a program integrating substance
abuse treatment with pretrial case processing is implemented
in a jurisdiction, the courts and most or all other justice system
agencies will be performing new functions. Reorganizing operating
procedures will involve costs, especially if new equipment must
be purchased or new staff must be hired. The following is a
list of the types of costs that can potentially be incurred:
Salaries and fringe benefits for justice system personnel
working on the program
Court personnel (judges and staff)
Prosecutor's office staff
Defense services
Pretrial services
Probation services
Jail personnel services.
Computers, software, and programming services
Drug testing equipment and lab services
Costs of facilities and services used to impose consequences
for noncompliance with program conditions
Other costs. Some costs cannot be easily allocated
to either treatment or the justice system. They include:
Costs of transportation of clients
From court to detoxification or treatment facility
From client's home to court or treatment.
Program evaluation
Costs of consultants to assist in program design, education,
training, and ongoing monitoring and review of operations.
Cost-benefit analyses can not only justify a program to outside
funding sources; they can help leaders decide how to reallocate
funding internally too. A study recently published by the California
Department of Alcohol and Drug Programs (CALDATA) illustrates
ways that costs can be broken down. The study analyzed benefits
in relation to costs in three broad areas: (1) the effects of
treatment of participant behavior, (2) the cost of treatment,
and (3) the economic value of treatment to society.
Some of the variables in the criminal justice system that
can -- and should -- be measured using the CALDATA methodology to
determine cost benefits of treatment are
Reductions in costs associated with defendants involvement
in the criminal justice system
Costs per arrest
Costs of crime-related court case processing and legal services
Costs of incarceration in prison and jail
Costs of probation and parole services
Costs related to victim losses, including thefts.
Reduction in costs of the health care system
Costs of outpatient and inpatient medical care related to
substance abuse
Costs of emergency care
Costs of inpatient and outpatient mental health care
The costs of those who have communicable disease that is
untreated (e.g., TB, HIV, other STDs).
Increased economic productivity of program participants
Increased earnings
Reduction in costs related to welfare and other social services.
The 2-year CALDATA study examined outcomes for a sample of
nearly 150,000 persons who received substance abuse treatment
in California in 1992, and found that the cost of treatment was
$209 million. The benefits, in terms of cost savings during
treatment and the first year after were approximately $1.5 billion.
Thus, for every dollar spent on treatment, about $7 was saved,
mainly in reduction of criminal activity and in the hospitalizations
for health problems.
At the local level, program managers can follow the CALDATA
study approach in estimating program benefits in relation to
costs. Equally important, they can use the evaluations to garner
outside funding.
Once the costs of program components have been identified,
it is time to develop funding strategies. It is important to
remember at this point that not all costs of a program are necessarily
new costs. The functions being performed by the program are
to some extent displacing functions previously performed, and
many if not all of the justice system costs can be met by reorganizing
staff and procedures. The principal costs for a treatment drug
court program are likely to be the costs of treatment services.
There are a variety of ways in which these costs can be met
including
Insurance reimbursement through the defendant's own
health insurance or through Medicaid or other publicly funded
insurance
State or local funding of substance abuse treatment services
Grant support for treatment services, from foundations or
public agencies
Fees paid by defendants participating in the program.
Most of the treatment drug courts created since 1988 were
started without significant infusion of outside resources
and often without any outside resources whatsoever. They were
developed through local initiatives, using local resources. More
federal funds have become available in the last year from the
U.S. Department of Justice's Office of Justice Programs. The
major support for the treatment infrastructure remains the U.S.
Department of Health and Human Services' Center for Substance
Abuse Treatment.
Particularly in view of the uncertainty of federal grant support,
it is important for planners to involve potential state and local
funding sources from the outset. In this connection, the office
of the State Alcohol and Drug Abuse Director has a particularly
important role. This agency has significant responsibility for
the allocation of Federal and State funds available for substance
abuse treatment and can be an invaluable source of assistance
in program design as well as direct funding.
Even if Federal or foundation funding is available to help
get a program off the ground, long-term funding support will
have to come principally from State and local sources. If representatives
of these sources are involved from the outset, they can be educated
about the goals and values of the program, and they can also
advise program leaders about what indicators of success will
win the program long-term funding support.
Although the long-term viability of treatment drug court programs
will depend mainly on their capacity to persuade State and local
funding sources of their worth, there are a variety of short-term
approaches to funding that warrant attention from program planners.
These include the following:
Volunteers. Programs integrating substance abuse treatment
with pretrial case processing require a great deal of labor.
The provision of ancillary services, in particular, is an area
in which volunteers can play an especially valuable role. Community
service organizations, professional organizations, and interested
individuals are potential sources of volunteer assistance. Volunteers
will need training (and training costs must be built into the
budget), but they can be immensely valuable assets to a program.
Grants. A valuable asset to a program is a person
with experience in preparing grant applications, either as an
employee or as a consultant. These individuals can help identify
potential funding sources and prepare persuasive proposals to
government and private funding sources.
Local philanthropists. Philanthropists in the community
are often willing to contribute to creative programs that cannot
be funded by government grants or other conventional funding
sources. The Foundation Center in Washington, D.C. publishes
a directory of philanthropic organizations and the types of programs
they fund. Health and human service-related projects are funded
by a number of foundations, including the Robert Wood Johnson
Foundation, the Annie E. Casey Foundation, and the Pew Charitable
Trust.
Nontraditional partners. Treatment drug court programs
provide opportunities for new partnerships involving the justice
system, the treatment community, and a wide range of organizations
that ordinarily have little or nothing to do with courts or substance
abuse treatment. For example, chambers of commerce and other
civic organizations may be able to provide job placement services
or apprenticeship programs. Grocery stores and restaurant chains
can provide jobs. Churches can provide meeting space for support
groups as well as emotional sustenance.
Entitlement and insurance income. It is important
for program leaders to know what entitlements and insurance income
their clients are eligible for. Some defendants are eligible
for entitlement programs that can help fund substance abuse treatment
and ancillary services. For example, clients with children may
be eligible for funds and services from State programs in the
areas of child care, nutrition, housing, and employment. Younger
clients may be entitled to educational support. Many clients
will probably be eligible for employment funds in the community.
Veterans of the armed services are probably eligible for a wide
array of Department of Veterans Affairs programs. The local
public health agency will be likely to have a number of programs
for which clients are eligible, including ones on prenatal care,
family planning, nutrition counseling, TB testing, STD prevention,
and HIV/AIDS education.
There are a number of "third party payment systems" that can
potentially be used to help fund substance abuse treatment, depending
on the circumstances of the individual defendant/client. They
include:
Medicare
Supplemental Security Income (SSI) disability assistance
CHAMPUS (the Federal system of health care payments for military
personnel and their dependents)
In recent years, health care reform has been a major focus
of attention for the States. While there is no way to accurately
predict how laws governing funding for health care (including
substance abuse treatment) will change, it is certain that managed
care will continue to place stringent time limits on health care
services. As drug courts develop, regardless of their initial
sources of funding, judges will need to be aware of new legislation
and regulations affecting funding for substance abuse treatment
services and initiate discussion on alternative policies that
support drug court objectives.
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