In December 2018, NPC Research, an independent, nationally recognized research firm headquartered in Portland, Oregon, completed a study entitled, “Bringing Treatment Court to Scale in Montana” at the request of the Montana Supreme Court and the Montana Healthcare Foundation (who funded the report). The purpose of this study was to respond to current attention on substance use disorders as a key health challenge in Montana, and the powerful role that treatment courts can play in addressing this problem; to review the current reach of treatment courts in Montana; and to explore the interest in, feasibility of, and resources required to expand treatment courts in the state.

To develop the report, NPC Research conducted literature reviews; interviewed program staff, state agency leaders, and organization partners; conducted a survey of rural treatment court programs nationally; conducted a survey of statewide drug court coordinators nationally; and summarized crime, funding, program, and policy data.

The full report includes explores the effectiveness of treatment courts, innovative models for rural jurisdictions, best practices related to drug testing, impact of DUI courts, the current scope of treatment courts in Montana, best practices in use by Montana treatment courts, services and resources needed for successful treatment courts, strategies for funding treatment courts, peer support models, and recommendations for expanding access to treatment courts.

Summary and Conclusions

Overall, the researchers found extensive need, support, and enthusiasm for the treatment court model, interest in developing additional programs in Montana, and many practical and feasible suggestions for how the expansion could work. Given the current widespread concern regarding substance use disorders and their impact on Montana communities, there seems to be an opportunity to pursue the needed rule changes and funding streams, particularly if key state agencies can be brought together to undertake this effort as a common goal.

Recommendations

The following recommendations are provided in order of priority, starting with the items that generated the most conversation and concern:

1. Increase funding for treatment courts in Montana.
   1. Advocate for state funding through increased general fund allocation or identify alternative funding streams to develop new treatment courts in targeted areas with identified needs and expand capacity in existing programs.
   2. Maximize use of Medicaid funds for treatment services. Maintain Medicaid expansion in Montana – it is the source of treatment for most drug court participants. Ensure providers understand how to maximize billing through Medicaid and the block grant for substance use dependency treatment and mental health services, as well as connect participants to healthcare providers.
   3. Pilot ways to fund treatment services outside of Medicaid and block grant reimbursement, to ensure programs can provide staff time for needed treatment court activities (such as attending staffing and court sessions), and cover services for people who do not have insurance or Medicaid.
   4. Provide a grant writer who can support programs or the state in accessing available grant funding to supplement or expand treatment court services, such as what the Montana Healthcare Foundation has been providing.
   5. Continue to encourage teams that want to start a new program to seek out grant funds from federal sources for implementation, due to the variety of resources that are available, such as training and technical assistance, as well as funds for planning and programming.
   6. Write a statewide implementation grant for federal funds, with the understanding that when federal funds run out, state funding will be needed for continuation. Designate the Drug Treatment Court Advisory Committee to be responsible for identifying and determining the areas of greatest need for expansion and development of new programs.
2. Increase collaboration related to treatment courts in Montana.
   1. Set up meetings for discussion and collaboration among partners within the state (Supreme Court/Judicial Branch staff and Department of Corrections, County Attorneys, Office of the Public Defender, Department of Public Health and Human Services, Federally Qualified Health Centers & hospitals, and Montana Tribes).
   2. Work to increase collaboration between treatment courts and primary healthcare providers.
3. Explore resources for utilizing telehealth approaches to increase services in rural areas.
4. Dedicate resources to ensure consistent available training is accessible to all roles and teams.
5. Continue to monitor and follow best practices in drug testing.
6. Continue to encourage programs to invest in and utilize a statewide treatment court data system.
7. Continue to monitor and assess all programs to ensure compliance with best practice standards, require action plans for identified deficiencies, and provide them feedback for continuous program improvement.
8. Pursue inclusion of peer support for treatment courts, utilizing peer mentors who are thoroughly trained (e.g., in addiction, treatment, etc.) to understand and work effectively with participants.
9. Work to increase the number of Licensed Addiction Counselors.
10. Have the Drug Treatment Court Advisory Committee recommend a change in state law to allow judges the discretion to require treatment court participation as part of probation or a family child abuse and neglect plan.
11. Have the Drug Treatment Court Advisory Committee explore options for addressing the concern that was raised in interviews regarding the shortage of clinical supervisors for treatment court providers.

Report Graphics of State and Tribal Treatment Court Locations