Study Review

Family Drug and Alcohol Courts

A structured intervention to address parental substance misuse supported by a multi-agency intervention team

Outcome Overall

This rating shows how effective the intervention is at achieving the evaluated outcome.

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Strength of

This rating shows how confident we can be about a finding, based on how the research was designed and carried out.

Family reunification Overall effectiveness: 1 (maximum 2) Strength of evidence : 3 (maximum 3)
Care re-entry and re-abuse Overall effectiveness: 0 (maximum 2) Strength of evidence : 3 (maximum 3)

Headline points

  • This summary comes from the original systematic review: Zhang, S., Huang, H., Wu, Q., Li, Y., & Liu, M. (2019). The impacts of family treatment drug court on child welfare core outcomes: A meta-analysis. Child abuse & neglect, 88, 1-14.
  • An overall positive effect on family reunification, based on high strength evidence
  • No evidence of effect on care re-entry or further maltreatment
  • Most evidence was from the USA, with one study from the UK

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What is this?

Parental substance misuse is a common reason for families becoming involved with children’s social care in England. In 2017-18, 18 per cent of children’s social care assessments identified concerns about alcohol misuse and 21 per cent about drug misuse.

Family Drug and Alcohol Courts originated in the USA in the 1990s as a way of responding to these problems. They aim to help parents address their substance misuse issues, improve family functioning and reduce the need for children to enter care. This is a multi-disciplinary service model which aims to improve the coordination of services for families, such as social services, substance abuse treatment, therapeutic services, domestic abuse intervention, employment and housing. This package of support is overseen by a court, which monitors parent’s compliance and administers rewards and sanctions.

Family Drug and Alcohol Courts (known by various terms including as Family Treatment Drug Courts and Dependency Treatment Courts) have now been adopted in sites across the USA, in Australia, England and Northern Ireland.

How is it meant to work?

Family Drug and Alcohol Courts are meant to work by giving parents access to drug and alcohol treatments and other forms of practical and therapeutic support with regular reviews of progress and close oversight of the welfare and care arrangements for the children concerned. The role of the court (and possibility of sanctions) should help to maintain parents’ engagement with treatment and other services. Successful treatment should address any related child welfare concerns, so that children can remain living with their families. FDAC is different from other sorts of court interventions as it promotes a closer relationship between the family and the judge through more regular meetings, in a less formal environment. Judges typically do not wear robes and meet with families around a table rather than in a courtroom.

What are the evaluated outcomes?

  • Family reunification
  • Care re-entry and re-abuse

How effective is it?

Family reunification

Overall, Family Drug and Alcohol Courts tended to show a positive effect on family reunification. Children are more likely to return home after entering care. This is based on high strength evidence from 16 research studies and a total number of 7,085 participants.

Care re-entry and re-abuse

Overall, Family Drug and Alcohol Courts had no effect on care re-entry or re-abuse. This is based on high strength evidence from 8 research studies with a total number of 1,474 participants.

These findings suggest that while there is no evidence that Family Drug and Alcohol Courts lead to reduced rates of care re-entry or further maltreatment, there is also no evidence that they have a harmful effect on these outcomes. Most children using Family Drug and Alcohol Courts are in care at the start of the intervention.

Where has it been studied?

Seventeen studies were analysed for this review. Thirteen of these were carried out in the USA, in 3 the location was not stated (although the researchers were based in the USA) and one was based in England. The inclusion of this study provides some indication of how FDACs might be implemented in a UK context.

Who does it work for?

The review did not identify characteristics of participants or analyse which sub-groups particularly benefited from Family Drug and Alcohol Courts.

When, where and how does it work?

Three variants of Family Drug and Alcohol Courts were identified in the review. These were integrated, dual-track and parallel models. In an integrated model, the same judge oversees both care proceedings and the parent’s compliance with their substance misuse treatment. In the other two models, care proceedings and treatment compliance are overseen by two separate (or near separate) courts.

This review compared the effectiveness of integrated Family Drug and Alcohol Courts with non-integrated courts and mixed models (where the study included some courts that had used an integrated model and some that had used a non-integrated model). It found that non-integrated and mixed models improved the likelihood of reunification, compared with integrated models. The Family Drug and Alcohol Court model that has been implemented in the UK uses an integrated model.

The review also found that studies that observed outcomes over 13-24 months were more likely to show a positive effect, compared with shorter periods of observation (under 12 months) or longer periods of two years or more.

What are the costs and benefits?

There is no robust information on the cost-benefit of this intervention.

How is it implemented?

Family Drug and Alcohol Courts have been implemented in a range of models. These models vary in relation to eligibility for participation, the professionals involved in delivery, guidelines for parents’ compliance with treatment and the types of services that are available to participants.

Features of specific models were not identified in the review. This section will set out key features of the UK-based Family Drug and Alcohol Court (FDAC) model developed by the FDAC National Unit.

How is it delivered?

Families are referred to the FDAC as part of pre-proceedings or when care proceedings are being issued. Families are eligible if there is a history of parental drug or alcohol misuse that could impact on the children’s health or development. Families will often have additional problems such as domestic abuse and mental health difficulties. Parents’ participation in the FDAC is voluntary and if they do not wish to be involved, their case will be heard by the usual family court. Once involved, a judge reviews the family’s case every fortnight, with the support of an independent multi-disciplinary Intervention Team. The parents are helped by the Intervention Team to make changes needed to ensure the children’s safety, within agreed timescales set by the court.

FDAC (UK) follows this process:

  • An initial FDAC assessment is carried out if the parents consent at the first court hearing. This assessment will include consideration of the parents’ mental health. The children’s needs are assessed within the first 8 weeks of proceedings, with involvement from all relevant children’s professionals
  • Following assessment, the Intervention Team helps the parents to agree an Intervention Plan. The plan will specify timescales for the children, the parents’ goals and the treatment and support to be provided in the next 4-8 weeks
  • This plan is adopted by the court, and committed to by the family, at the second court hearing
  • The ‘trial for change’ then begins. Fortnightly hearings are held to encourage the parents/carers, review their progress, review the Intervention Plan, address problems that might arise and make decisions to help achieve permanency for the children as quickly as possible. For each hearing the Intervention Team provides a report about how well the Intervention Plan is going, including engagement in treatment and results of drug and alcohol testing
  • At the fortnightly hearings, the family will talk directly with the judge, without a lawyer present. This continues unless there are problems, in which case the family may return with lawyers at the next hearing
  • Once parents have abstained from using drugs or alcohol for some months, there will be an assessment of their relationship with the children and their capacity to meet their children’s needs
  • At the third intervention planning meeting (c. 18 weeks into proceedings), the Intervention Team will advise whether parents have made enough progress for children to be placed permanently in their care
  • The court holds an Issues Resolution Hearing (c. 20 weeks) to decide when to bring proceedings to an end
  • Proceedings will usually be brought to an end within 26 weeks. In some cases if families are making progress, this timescale may be extended before the final hearing.

Interventions put in place by FDAC to support the family might include abstinence from drugs and alcohol, supported by a community substance misuse programme; support to address any underlying problems (e.g. mental health problems or domestic abuse); support to strengthen relationships between family members; and help to make lifestyle changes to enable the parents to prioritise the children’s needs.

Who can deliver it?

In the UK, the FDAC team is made up of a District Judge and an Intervention Team, which includes Child Protection Social Workers, a Psychiatric Nurse, Substance Misuse Specialists and Parent Mentors, who have experience of recovering from substance misuse and may also have experience of care proceedings. The team also has input from a Child and Adolescent Psychiatrist, an Adult Psychiatrist and Therapists. In the London FDAC there is also a domestic abuse expert.

What are the training and supervision requirements?

In the UK model, FDAC Judges are trained to help families stay motivated, solve problems and take charge of their own lives. The other professionals involved will have their usual professional qualifications and supervision arrangements.

What supports good implementation?

In the UK, the FDAC National Unit developed a set of Service Standards and Practice Indicators to enable sites setting up a new FDAC to achieve fidelity to the model. There is a starter pack for those interested in setting up an FDAC. The Centre for Justice Innovation now supports the expansion of the Family Drug and Alcohol Court model to new areas.

In the USA, a set of guidelines for developing Family Drug Courts has been published by the Office of Juvenile Justice and Delinquency Prevention (OJJDP).

In summary...

  • Overall, Family Drug and Alcohol Courts tended to show a positive effect on family reunification, compared with usual services. This finding was based on high strength evidence
  • There was no evidence that Family Drug and Alcohol Courts had an effect on care re-entry or further maltreatment of children
  • Further analysis found that non-integrated models or studies that included a mixture of integrated and non-integrated models showed a greater effectiveness. However, this finding should be interpreted cautiously
  • Most of the studies were carried out in the USA, with only one of the included studies located in the UK. Therefore, it should not be assumed that these findings are equally applicable to the UK
  • Future research is needed, including a cost analysis of Family Drug and Alcohol Courts, to determine whether they offer good value for money in the treatment of parental substance misuse and support to improve child welfare

Further resources

This summary comes from an original systematic review called: The impacts of family treatment drug court on child welfare core outcomes: a meta-analysis. (Zhang, S., Huang, H., Wu, Q., Li, Y., & Liu, M.) Published 2019.

The EMMIE summary of the above meta-analysis of FDAC provides evidence that FDAC is effective. The accompanying rapid realist review (and summary report) detail learning from international implementation and delivery of FDAC, and combines it with UK stakeholder engagement, to provide a timely and meaningful evidence summary to support best FDAC practice in the UK.

The aim of these reports (summary and full report) is to provide practical guidance for implementing FDAC. The guidance is provided in the form of a programme theory about how FDAC works, for whom, and under which circumstances, and practice-focused tables outlining how to deliver FDAC to achieve two key stages: creating an internal change to increase parent engagement in treatment and creating parent behaviour change through treatment.

The findings of the meta-analysis summarised in our EMMIE summary, combined with our findings in this report, suggest that FDAC provides parents with a structure that supports them to make positive behaviour change, making it more likely that they will be able to keep their children safely at home.