As we work urgently to adjust our programs in New York to meet the COVID-19 pandemic, we’re also helping practitioners around the country. Our expert assistance team has been working urgently with drug treatment court practitioners to brainstorm alternatives to help participants maintain sobriety, even when courts and treatment programs are closed, and check-ins can no longer take place in-person.
“Late last week, statewide drug court administrators all started e-mailing each other and raising the alarm of how this virus could impact the operations of treatment courts,” says Annie Schachar, director of the Center’s Treatment Court Programs, who describes the challenges to treatment courts posed by COVID-19 on the latest episode of In Practice.
Treatment courts rely on face-to-face interactions with participants. They also typically require frequent in-person drug testing. And those who receive medication, such as methadone, typically have to show up on a daily basis to receive it.
Schachar worries about the impact of closures. “The people who are in treatment are among our most vulnerable populations,” she says. Many have health problems, have recently been incarcerated, and face food or housing instability.
Within days of hearing from statewide administrators, Schachar’s team hosted a webinar [slides available] explaining the challenges and providing advice. “At the time that this came to our attention, the question wasn’t really yet, ‘what’s going to happen if court systems completely shut down?’" But within days, many treatment courts ceased or reduced operations.
“There have been a lot of, shall we say, creative solutions,” Schachar said.
Schachar’s advice is to prepare for the worst-case scenarios. “The most prudent course of action right now would be to develop contingency plans that assume a full shutdown of courts and potentially of treatment providers as well,” she said.
She also hopes courts will “take a step back from a hardline approach of making sure everyone is getting drug-tested,” and focus for now “on basic health and safety needs.”
Among the Center’s other advice for practitioners:
- provide participants with information about how to stay healthy and access food and other essential resources during the outbreak;
- use remote technology and tele-services, including social media platforms, to stay in touch with participants;
- use remote technology to maintain regular team meetings so that staff can continue to track the status of clients.
The following is a transcript of the conversation.
Annie Schachar: We're really hoping that courts will understand that now is the time to focus on everybody's safety and health, and make sure that people aren't feeling isolated. And to maybe take a step back from the hard line approach of making sure that everybody's getting drug tested, making sure that the courts are delivering sanctions.
Rob Wolf: Hi, this is Rob Wolf, director of communications at the Center for Court Innovation, and this is In Practice. A podcast where we speak with people who are in the field, working on justice reform, exploring new ideas. And at the moment we are thinking about and talking about the thing that is affecting everyone and everyone's life at home and at work and in the justice system. COVID-19, the novel coronavirus.
In our office, we have changed everything right now. People are working from home as much as they can. The court system is focusing just on what it calls essential business. We are trying to figure out what we're doing and we are adapting on the ground and we're adapting to meet the needs of our communities and the people we serve. And those communities include court systems around the country that turn to us for advice.
And today I'm speaking to one of our experts, Annie Schachar, director of Treatment Court Programs at the Center for Court Innovation, and she works with courts and practitioners who run and work with treatment courts around the country, and she and her team have been helping and advising those courts as they've tried to adapt to COVID-19.
So Annie, thank you so much for taking a few minutes to answer some of my questions.
Annie Schachar: You're welcome. I'm happy to.
RW: Just for context, Annie and I are both now at home, as many of our colleagues are. And Annie, how are you holding up right now?
AS: I am holding up just fine. Thanks for asking Rob. How about you?
RW: I'm okay. It's taken some getting used to. Anyway, we're all in this together. Why don't we start out with you maybe just explaining in the normal course of things, what does your team do? That treatment court team.
AS: Sure. So the treatment court team is comprised of a whole bunch of people who are former practitioners. Many of us have worked in drug treatment courts in the capacity of a lawyer or a treatment provider or working for a court system. So we all have a lot of experience working in treatment courts. And what we normally do in our business as usual lives, is we provide training and technical assistance to court administrators and treatment court practitioners around the country. Both in helping them plan and implement and study and improve their adult drug treatment courts, veterans treatment courts, opioid treatment courts, and all types of treatment courts around the country. We do a lot of webinars, we do a lot of training. We go to conferences, we work with individual sites, and we work with states to really get into the issues affecting their treatment court systems, and help them try to improve them.
RW: How many treatment courts are there in the country, if you happen to have those numbers at your fingertips?
AS: Over the past 30 years, there's been a lot of research as to what are the best practices in operating a treatment court. And by those standards there's approximately 3000 of them in the country.
RW: So let's talk about COVID-19 because this is new for everybody. We're all adapting to this news and everyday things seem to be changing. When did you realize that this news, this disease, which has become a pandemic, was going to affect the work of drug treatment courts?
AS: So I think about late last week, sometime on Thursday or Friday, so the 12th or 13th of March, and in those days around then the statewide drug court administrators, which is a group of about 45 state level drug court administrators that we consult with, or to, all started emailing each other and really raising the alarm bells about how this virus could potentially impact the operations of treatment courts.
So for those who aren't terribly familiar with the model, some of the elements of a treatment court involve people who are suffering from substance use disorder who have been screened and assessed and brought into a drug court program, they have to come to court pretty often and they also have to engage in treatment and meet with case managers, I meet with treatment providers, talk to the judges, talk to the lawyers. So there's a lot of face to face human interaction involved in treatment courts, as well as supervision.
Most people who are in a treatment court are subject to quite frequent drug testing, which of course is done in person, and it's usually done through uranalysis. So again, about mid to late last week, the coordinators all started frantically emailing each other and reaching out to us for some support, wondering what are we going to do if courts start to slow down or treatment providers don't have enough capacity or if lots of people are getting sick. But I have to tell you, Rob, at the time that this came to our attention, the question wasn't really yet what's going to happen if court systems completely shut down? Because that really wasn't on anyone's mind yet. And I think it's important to point that out because we've had to be really, really quick and nimble in providing assistance and advice for them in a very quick moving situation.
RW: And so what has in fact happened? Have a lot of court systems actually shut down? For instance, what's going on in New York? I do know they've moved to only doing essential hearings. Having someone come in for a monitoring or drug test to someone that might be essential. But I assume that that's probably not meeting the definition here in New York.
AS: That's a good assumption. So in New York state, the administrative chief judge has issued an order that criminal courts should only be performing essential functions. And then he went on to describe what those essential functions look like. And there's a whole long description of what might qualify as an essential function, including ongoing jury trials, and arraignment and so on and so forth. But there's no mention specifically of treatment courts. And from that we can infer that treatment courts are not to be operating during this, what's essentially a shutdown of the courts, or at least a very significant scale in back of court operations in New York state.
So I know just today, some of the offices that oversee treatment courts in the state have started to figure out what the strategies will be. And it sounds like it's been a little bit of an ad hoc reaction to the announcement from the chief administrative judge because of course there wasn't very much warning, which is the case across the board with this virus. Everything's happening very quickly, and advice from public health officials is moving really quickly and everyone's just doing their best to catch up.
So what I've heard from not just New York state but around the country is some treatment courts have ceased operations completely until some date, far off in the future. Sometime in April, maybe sometime in may, some treatment courts around the country in areas where the outbreak hasn't been as bad yet have been operating their courts at a lesser capacity, where they're not allowing every participant to show up for court at the same time. People have to wait outside in the hallway and get called in to see the judge one at a time. And when they wait out in the hallway, they have to stand far apart. So there's been a lot of different, shall we say, creative solutions.
But when we talk to the coordinators as a group yesterday, which I want to tell you about, our advice to them was we're not doctors, we're not public health officials, but it seems to be that the most prudent course of action right now would be to develop contingency plans that assume a full shutdown of courts, and potentially of treatment providers as well, because that's the way things seem to be heading and for the courts that have put a lot of effort into building contingency plans that include the courts being open, I think they're going to be seeing soon that they'll have to adapt.
RW: And what is the consequence for clients who are in a treatment program, in a treatment court, they're in the middle of this process. It's a very well thought through process and suddenly it sounds like it's getting upended. What is the cost of that? What does that mean for individuals? What does that mean for the practitioners?
AS: The cost really is huge and it's really hard to say right now, but of course the people who are in treatment courts are often some of our most vulnerable population both medically and socially as well. So medically we have people who they've been using drugs for a long period of their life. It's not unlikely that they might have compromised immune systems, maybe from diseases and infections that they've contracted as a result of intravenous drug use. Many of them are older. They might have poor respiratory cardiovascular or pulmonary health disorders. Many of them are longtime smokers, so they're physically, medically, potentially a very high, very vulnerable group.
And then socially as well. A lot of people who come to drug courts are homeless. They have recent experience with incarceration. They have other instability factors in their life, like income and stability, food and stability. They use social services that are getting shut down right now. Some of them are living in an abusive relationship, most of them are lower income. So we're really talking about a very vulnerable segment of society here and those who really rely on the support that they're getting from their programming, especially from their treatment providers and counselors, and the court system as well, in the case of treatment courts.
RW: So what does that mean as far as prospects for their ultimate recovery? It sounds like it could be absolutely devastating on people who count on the support to achieve sobriety.
AS: Mm-hmm (affirmative). It has the potential to be incredibly disruptive to very many people, but what we've been trying to do on our team, at the treatment courts team, at the center for court innovation is to help those who work in the part of the justice system that oversees drug courts to get out some resources and some suggestions and some considerations to the folks who are actually boots on the ground working in the treatment courts to help minimize the disruption as much as possible.
So things that we've been providing advice on are really how to stay connected with participants during this very stressful time, which can be ... Encompasses a whole range of things like providing participants with resources that they might need to navigate this. Whether it's making sure they know how to access food, making sure they know just the basics of keeping safe during the viral outbreak, linking them up with any kinds of support, local housing updates, disability support, things like that. And then using tele services and different kinds of social media platforms to stay connected when it's impossible to actually be physically in the same place.
So something that we've provided a lot of guidance on in the past is using kind these HIPAA compliant platforms for engaging with drug court participants and providing treatment. But actually just today, or I think it was yesterday on the 17th of March, the department of health and human services announced that it's going to cease imposing penalties for HIPAA violations against healthcare providers who are delivering services through tele services, which means that treatment providers can now turn to things like FaceTime or WhatsApp or Skype or anything that's available to them to provide treatment for their clients at a distance. Normally there's some pretty strict restrictions on how that can be delivered to maintain compliance with privacy requirements, so that's been relaxed, and that's some information that we've pushed out to the field to make sure that practitioners are aware of this.
RW: A lot of that has to do specifically with treatment. What about core operations? In a treatment court, as you said, people often show up for review hearings. The judge sees them, they check in. The relationship with the judge is important. I've seen in many evaluations where if the judge gives approval for a job well done, that goes a long way towards helping someone on the path towards recovery. The judge might also give sanctions. So our courts, have you seen that yet? Do we know if courts will be able to remotely carry out their functions like that?
AS: Yeah. So there are some courts that we've actually been working with over the past few years that are already equipped to maintain court operations remotely, because there are a lot of very rural jurisdictions in this country where the only treatment court is ... There's only one treatment court. So people who live nearby have been using tele services to link in to courts for a while. But I think this is a little bit of a different situation because the court itself might not be operating anymore. So something we've been talking about and hearing from some of the statewide coordinators is that people are getting creative, everybody's getting creative. We're getting creative right now, you and me Rob having this conversation over the phone. But we've suggested that courts consider having their judges send text messages or record a little video message back can be sent out to participants. We've encouraged drug court teams who typically will hold a staffing meeting every week in person, to maintain those staffing meetings every week by phone, by Zoom, by Skype or whatever. Make sure that they're still aware of what's going on with every client, and if there's a situation where it would benefit the client to have some interaction with the judge or the team, figure out a way to do that over some kind of face to face social media platform, or even just pick up the phone and call.
We're really hoping that courts will understand that now is the time to focus on everybody's safety and health and make sure that people aren't feeling isolated and to maybe take a step back from a hard line approach of making sure that everybody's getting drug tested, making sure that the courts are delivering sanctions. It's really a time to step back from that and focus on just basic health and safety means.
And I just want to point out that there's ... We haven't touched on this much yet, but we've been working a lot with opioid courts as well, and of course we know that the country's in the midst of a big opioid crisis. And opioid users I think are at a very specific risk because of the highly addictive nature of opioid drugs, and many, many people who are in drug treatment courts are also on some form of medication for opioid use disorder, whether it's buprenorphine or methadone. So that adds another layer of complication because people have to get to doctors often, or to prescribers and to get their medication. And that medication is key to keeping them safe and healthy. If they don't have their medication, they're really at very high risk of overdose. But SAMHSA has actually put out guidelines, national guidelines-
RW: What is SAMHSA again? That's a federal agency that,
AS: Yeah, SAMHSA is the federal agency that over overseas substance use and mental health services. And so substance use and mental health services administration. So they're the ones who oversee medication for opioid use disorder and opioid treatment programs where people go to get methadone. And typically, especially for people who aren't stabilized yet, they have to go everyday to an opioid treatment program to get their methadone. And what SAMHSA has done in the face of this crisis is to relax the rules for letting people take up to, in some cases, 28 days of their medication home with them. So for people who are stable enough, they can take their medication home with them. That way they don't need to come outside and stand in and a line and interact with other people every single day to get their medication. Now this is obviously, I think it's an unprecedented relaxation of the rules by SAMHSA and it's a really great first step, but we're only a few days into this really, and I can foresee that there might be some real difficulties with the supply chain because if you have everybody who normally gets their medication every day going to their providers in one week trying to get 30 days worth of it, we might see some really dangerous fallout from that.
So we're closely monitoring the situation so that we can help our stakeholders and our partners provide the best advice as possible to their drug court teams.
RW: Well, it sounds like you guys have been, as a field, and at the center for court innovation, your team Annie, really on the ball. You've adapted so quickly to this fast moving situation. As you say, it was just a week ago that this emerged as a problem for the treatment court world, and already you've gotten ... You've just gave out a list of good advice and going forward, how are you staying plugged into how needs are changing, especially since things seem to be changing so quickly.
AS: We're just doing our best to keep in touch with the people who work in the treatment courts. There are the ones who are going to tell us what's going on. They're the ones who are going to bring us their challenges, let us know where they need help and more resources. And a big focus of what we do on our team is bringing those practitioners together to share ideas with each other because it's the people who do the frontline work who have the best solutions. So we were planning on a weekly basis to provide a forum for the statewide drug court coordinators to communicate with each other, and share innovative solutions that they've come up with, raise questions with the group, and then we're all ... We're taking that information back as well and sharing it with the practitioners within the center for court innovation. So we've created this big feedback loop and we're really hoping that we can help everybody stay on top of this crisis as it unfolds.
RW: And you just did a webinar this week too, is that right?
AS: We did. We did a webinar yesterday that was intended for the statewide drug court coordinators. There are about 45 of them, but 70 people logged in. So I know that people were sharing the invitation, which is great. It really shows that there's a need for it, and Dave Lucas from our team presented on some of the key elements of making sure that people are supported from a clinical perspective, and then Sheila McCarthy from our team presented on some of the technology platforms that are available for drug courts and drug court practitioners to use in this new era of social distancing.
RW: And can people expect that you guys will be doing more of those in the future to keep people up to date on our emerging best practices?
AS: I'm really hoping that we can pull that off. We're going to do our best to push resources out to the field as quickly as we can.
RW: I've been speaking to my colleague Annie Shacker, the director of treatment court programs at the center for court innovation and we've been talking about how her team and the treatment court community around the country has been responding as nimbly as they can over the past week to the COVID-19 health crisis.
Thank you. Thank you so much for taking the time to talk to me.
AS: You're welcome. Thanks Rob.
RW: And I'm Rob Wolf, director of communications at the center for court innovation. This has been in practice, a podcast of the center for court innovation, and we hope to bring you more updates from the front lines of how the justice field is responding to COVID-19, and beyond the justice field as well, how communities are responding. How everyone's responding. Thank you for listening.