title: Beyond recidivism: changes in health and social service involvement following exposure to drug treatment court.
abstract: BACKGROUND
  The majority of Drug Treatment Court (DTC) research has examined the impact of DTCs on criminal recidivism. Comparatively little research has addressed the association between DTC participation and engagement with community-based health and social services. The present study investigated changes in participant involvement with outpatient healthcare and income assistance within a DTC cohort. We hypothesized that involvement with community-based (outpatient) health and social services would increase post-DTC participation, and that service levels would be higher among program graduates and offenders with histories of co-occurring mental and substance use disorders.
  
  
  METHODS
  Participants were 631 offenders at the DTC in Vancouver, Canada (DTCV). Administrative data representing hospital, outpatient medical care, and income assistance were examined one-year pre/post program to assess differences over time. Generalized estimating equations were used to investigate the association between changes in service use and program involvement. We also examined the relationship between level of service use and offender characteristics.
  
  
  RESULTS
  Members of the cohort were disproportionately Aboriginal (33 %), had been sentenced 2.7 times in the 2 years preceding their index offence, and 50 % had been diagnosed with a non substance-related mental disorder in the five years preceding the index offence. The mean number of outpatient services post DTCV was 51, and the mean amount of social assistance paid was $5,897. Outpatient service use increased following exposure to DTCV (Adjusted Rate Ratio (ARR) = 1.45) and was significantly higher among women (ARR = 1.47), program graduation (ARR = 1.23), and those previously diagnosed with concurrent substance use and mental disorders (ARR = 4.92). Overall, hospital admissions did not increase post-program, although rates were significantly higher among women (ARR = 1.76) and those with concurrent disorders (ARR = 2.71). Income assistance increased significantly post program (ARR = 1.16), and was significantly higher among women (ARR = 1.03), and those diagnosed with substance use disorders (ARR = 1.42) and concurrent disorders (ARR = 1.72).
  
  
  CONCLUSIONS
  These findings suggest that the DTCV was a catalyst for increased participant engagement with community health and social supports, and that rates of service use were consistently higher among women and individuals with concurrent disorders. Research is needed to investigate the potential link between health and social support and reductions in recidivism associated with DTCs.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada. sra20@sfu.ca.
authors.forename: Stefanie N
authors.initials: SN
authors.lastname: Rezansoff
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada. akm_moniruzzaman@sfu.ca.
authors.forename: Akm
authors.initials: A
authors.lastname: Moniruzzaman
authors.affiliation: British Columbia Corrections, PO Box 9242, STN PROV GOV, Victoria, British Columbia, V8W 9 J2, Canada. elenore.clark@gov.bc.ca.
authors.forename: Elenore
authors.initials: E
authors.lastname: Clark
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada. jsomers@sfu.ca.
authors.forename: Julian M
authors.initials: JM
authors.lastname: Somers
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002170:Canada; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D057237:Criminals / Q000523:psychology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D037141:Mandatory Programs / Q000331:legislation & jurisprudence*; D001523:Mental Disorders / Q000150:complications / Q000523:psychology; D012947:Social Work / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D055815:Young Adult