The UCF Court Health Services and Policy Workgroup, an interdisciplinary team led by Dr. Barbara “Basia” Andraka-Christou, received a competitive $150,000 award to evaluate enhancement and evaluation for Florida's Family Dependency Drug Courts. This three-year, $1.5 million project is funded by the Bureau of Justice Administration and was awarded to the Florida Office of the State Courts Administrator. The workgroup’s project evaluation involves examining the implementation process, implementation outcomes, and health service outcomes of evidence-based substance use disorder treatment, parenting engagement interventions and cultural competency practices in five family dependency drug courts across the state of Florida. The research team uses community participatory mixed methods to evaluate the program in four stages. The research approach is grounded in the EPIS Framework, Proctor’s Implementation Outcomes, and Centers for Disease Control and Prevention best practices for program evaluation.

Research Process

The UCF Health Services and Policy Workgroup is evaluating a three-year, $1.5 million grant funded by the Bureau of Justice Administration and awarded to the Florida Office of the State Courts Administrator (OSCA). The project evaluation involves examining the implementation process, implementation outcomes, and health service outcomes of evidence-based substance use disorder treatment, parenting engagement interventions, and cultural competency practices in five family dependency drug courts across the state of Florida.

The Centers for Disease Control and Prevention recommends two types of evaluations for these kinds of projects: 1) an implementation/process evaluation and 2) an outcome evaluation. (Process evaluations occur before outcome evaluations1.)

Process evaluations include documenting how the intervention was implemented, how people experienced the intervention, the degree to which essential elements were delivered, the context in which interventions were delivered, and the potential impact of contextual factors on outcomes1. For our process evaluation, we will use the Exploration, Implementation, Preparation and Sustainment framework (i.e. “EPIS framework”) to describe the stages of implementation as well as the context of implementation and related barriers or facilitators to implementation2. For process evaluation, we will also use Proctor et al.’s framework to describe implementation measures of fidelity, appropriateness, adoption, acceptability, penetration and cost3. For outcome evaluation, we will utilize best practices recommended by the Centers for Disease Control and Prevention1.

Aims

Our research will describe the intervention(s) selected by each court and the implementation context. Data collection for this aim includes documents provided by each court to the Office of the State Courts Administrator (i.e. court action plans), qualitative focus group data from court staff/judges and qualitative interview data with stakeholders from court staff/judges.

We will describe the intervention implementation process using the EPIS framework, which posits that implementation occurs in four stages: exploration, preparation, implementation, and sustainability. Our research team will collect and analyze data at each of these four stages for the duration of the grant project. Identification of the stage of implementation of each court is based on integration of qualitative and quantitative results.

Data about barriers and facilitators will be collected using qualitative methods informed by EPIS constructs. Qualitative data will be analyzed using the Iterative Categorization process. The EPIS framework explicitly assumes that different constructs may serve as barriers and facilitators during different stages of implementation2.
We will use Proctor et al.’s model to identify implementation outcomes, which are "the effects of deliberate and purposive actions to implement new treatments, practices, and services."4,p.95 This model posits that implementation outcomes predict health outcomes. For example, adoption of an intervention (e.g. medication) is an implementation outcome, while decreased relapse rates are a health outcome. The implementation outcome and health outcome are expected to be related in that relapse rates should depend on adoption of the intervention.

We will identify health outcomes and explore the causal relationship between the intervention implementation and health outcomes. Implementation of an evidence-based intervention is expected to lead to a positive change in health outcomes. Health outcomes cannot be interpreted apart from implementation outcomes. For example, if a health outcome does not change as expected following intervention implementation, it may be due to lack of fidelity of implementation of the intervention, rather than lack of efficacy of the intervention. Therefore, our research team will primarily be providing results regarding health outcomes in the latter stages of the project, after we have collected comprehensive data on implementation outcomes.

Since the project involves courts rather than traditional healthcare settings (e.g. hospitals), we are conceptualizing health outcomes more broadly to not only include client health measures (e.g. relapse rates) but also court program completion and parent-child reunification. Information about expected outcomes for each intervention have been obtained and integrated from three sources: action plans submitted by courts to the Office of the State Courts Administrator, interview and focus group data, and scholarly literature (if available) on the intervention selected. Specific expected health outcomes for each court are available in the results section of this report.

References:

  1. Centers for Disease Control and Prevention. Types of Evaluation.
  2. Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health. 2011;38(1):4-23.
  3. Proctor E, Silmere H, Raghavan R, et al. Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda. Adm Policy Mental Health. 2011;38:65-76.
  4. Proctor EK, Warren G, Landsverk J, et al. Implementation Research in Mental Health Services: an Emerging Science with Conceptual, Methodological, and Training challenges. Adm Policy Ment Health. 2009;36.

Our Workgroup

The UCF Court Health Service and Policy Workgroup includes interdisciplinary faculty and graduate students with expertise in substance use disorder health services and policy, mental health services, qualitative methods, quantitative methods and mixed methods. Our goal is to help judges, court staff, court participants, and government agencies use evidence-based practices for substance use disorder treatment, including for opioid use disorder.

Contact the UCF Court Health Service and Policy Workgroup at CourtHealthResearch@ucf.edu.

Co-Principal Investigator
Danielle Atkins, PhD, MPA

Co-Principal Investigator
Yara Asi, PhD

Co-Principal Investigator
MH Clark, PhD

Co-Investigator
Brandon del Pozo, PhD

Other Workgroup Projects

Projects

Below are projects related to court health services and policy that our workgroup is engaged in.

Evaluation of the Florida Opioid Initiative

Our workgroup has been the primary research arm for the Florida Courts Opioid Initiative, led by the Office of the State Courts Administrator. We have conducted statewide surveys of court staff beliefs, social norms, perceptions of self-efficacy and policies related to medications for opioid use disorder. The research approach is based on the theory of reasoned action and planned behavior. We have also examined the relationship between training about medications for opioid use disorder and beliefs.

Designing Interactive Education about Medication for Opioid Use Disorder for Judges and Court Staff

In collaboration with the Office of the State Courts Administrator and software vendor Enfoglobe LLC, our research team has assisted with the design of educational modules about medications for opioid use disorder (MOUD), targeting judges and court staff in Florida. These modules offer a variety of interactive quizzes, animations, and videos, as well as information and resources to assist and engage judges, court staff and stakeholders in the field.

Access to the portal with interactive tools is freely available to Florida judges, court staff, and interested stakeholders.

Publications

Below is a sample of publications from our workgroup regarding court health services or policy.

Andraka-Christou B, Atkins D. Whose opinion matters about medications for opioid use disorder? A Cross-sectional survey of social norms among court staff. Substance Abuse; 2020. In press.

Barbara Andraka-Christou, Danielle Atkins, Beliefs about medications for opioid use disorder among Florida criminal problem-solving court & dependency court staff. The American Journal of Drug and Alcohol Abuse; 2020. 1-12. DOI

Andraka-Christou B, Atkins D, Madeira J, Silverman R. Receipt of Training about Medication for Opioid Use Disorder from Pharmaceutical Manufacturers: A Preliminary Study of Florida Criminal Problem-Solving and Dependency Court Staff. American Drug & Alcohol Review; 2020. 39(5): 583-587. DOI

Presentations

Below is a sample of presentations from our workgroup regarding court health services or policy.

Andraka-Christou, B., Atkins, D., Ahmed, F. Florida court staff beliefs and social norms regarding medications for opioid use disorder. Poster presentation at American Public Health Association Annual Meeting; October 2020; San Francisco, CA. (virtual due to COVID-19)

Andraka-Christou, B., Yara, A., Totaram, R. Court staff content and style preferences for educational videos about medication-assisted treatment. Poster presentation at American Public Health Association Annual Meeting; October 2020. San Francisco, CA. (virtual due to COVID-19)

Andraka-Christou, B. Medication-assisted treatment. Dependency Drug Courts All-Sites Meeting. Organized by the Office of the State Courts Administrator; September 23, 2020. Tallahassee, FL. (virtual due to COVID-19)

Andraka-Christou, B. Medication-assisted treatment. Florida Courts Opioid Initiative: Virtual Training. Organized by the Office of the State Courts Administrator; August 28, 2020. Tallahassee, FL. (virtual due to COVID-19)

Andraka-Christou, B. Medication-Assisted Treatment for Opioid Use Disorder & Courts. Oral presentation to the Florida Supreme Court Family Court and Problem-Solving Court Steering Committees. Organized by the Florida Supreme Court Office of the State Court Administrator; September 13, 2019. Orlando, FL.

Andraka-Christou, B. Medication-Assisted Treatment: Fostering Stability & Attachment for Pregnant & Parenting Women in Recovery. Oral presentation at the Zero to Three Annual Conference; October 3, 2019. Fort Lauderdale, FL.

Andraka-Christou, B. Busting Myths about Medication Assisted Treatment. Keynote presentation at 8th Circuit of Florida Bar Association Meeting; September 20, 2019. Gainesville, FL.

Andraka-Christou, B. The Opioid Crisis – How it Impacts You. Oral presentation. Organized by the Florida Department of Children & Families. August 29, 2019; Ft. Lauderdale, FL.

Andraka-Christou, B. Medication-Assisted Treatment for Opioid use Disorder. Panel Member. Early Childhood Court All-Sites Meeting. Organized by the Florida Department of Children & Families; June 14, 2019. Orlando, FL.

Andraka-Christou, B. Drug Courts & Medication-Assisted Treatment. Oral Presentation. Drug Court Improvement Panel. Florida Supreme Court Annex; May 13, 2019. Tallahassee, FL.

Below are projects related to court health services and policy that our workgroup is engaged in. Evaluation of the Florida Opioid Initiative Our workgroup has been the primary research arm for the Florida Courts Opioid Initiative, led by the Office of the State Courts Administrator. We have conducted statewide surveys of court staff beliefs, social norms, perceptions of self-efficacy and policies related to medications for opioid use disorder. The research approach is based on the theory of reasoned action and planned behavior. We have also examined the relationship between training about medications for opioid use disorder and beliefs. Designing Interactive Education about Medication for Opioid Use Disorder for Judges and Court Staff In collaboration with the Office of the State Courts Administrator and software vendor Enfoglobe LLC, our research team has assisted with the design of educational modules about medications for opioid use disorder (MOUD), targeting judges and court staff in Florida. These modules offer a variety of interactive quizzes, animations, and videos, as well as information and resources to assist and engage judges, court staff and stakeholders in the field. Access to the portal with interactive tools is freely available to Florida judges, court staff, and interested stakeholders.
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