INVESTIGATING THE PROGRAMMATIC ATTACK: A NATIONAL SURVEY OF VETERANS TREATMENT COURTS.

• Author: Baldwin, Julie Marie

TABLE OF CONTENTS I. INTRODUCTION 706 A. Veterans' Issues 707 B. The Specialized Court Movement 712 II. VTC RESEARCH AND THIS STUDY 715 III. THIS STUDY 717 IV. DATA AND METHODS 718 A. Survey Design 718 B. Creating the Population Frame 718 C. Data Collection and the Resulting Sample 719 D. Analysis 720 V. RESULTS 721 A. Establishment: National Compendium Results 721 B. Policy: Goals, Objectives, Target Populations, 722 Requirements, Benefits C. Structure: Funding, Jurisdiction, Judges, Stages, Components 724 D. Procedure: Meetings/Sessions, Identification, 725 Screening, Supervision VI. DISCUSSION 726 VII. LIMITATIONS 734 VIII. CONCLUSION 735 TABLES 738 FIGURES 750 I. INTRODUCTION

Of all the publicly funded responses to the intertwined problems of crime, mental illness, trauma, and substance abuse among veterans, the most recent programmatic innovation has been the rapid rise and wide diffusion of the veterans treatment court (VTC). VTCs are not military courts (courtsmartial). (1) They are a recently created specialized court within the public court system, joining drug courts, mental health courts, domestic violence courts, and gun courts in the specialized court movement. The general idea of VTCs is in line with that of other specialized courts. VTCs aim to divert veterans from the traditional criminal justice system to nontraditional channels of justice, providing them with appropriate treatment and services (e.g., mental health counseling, substance abuse treatment, and housing services) that attempt to address any underlying causes or correlates of crime, in an effort to eliminate or reduce future crime and contact with the system. (2) In jurisdictions where a VTC is in operation, eligible veteran dockets are transferred to the VTC. The VTC links the offending veteran to treatment and services in lieu of incarceration if the veteran opts into the VTC program. (3) VTCs represent a critical policy innovation built on two conceptual foundations: veterans' issues and the specialized court movement.

1. VETERANS' ISSUES

   A massive research base indicates that a distinct constellation of issues and needs results from military service or training. Due to the time allowed for research of veterans from the most recent era to begin and results to be published, the majority of these studies have focused on Vietnam-era veterans. However, as veterans return from Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND), research on veterans from those operations has recently emerged. (4)

   Approximately 25% to 40% of OEF/OEF/OND-era veterans have neurological and psychological injuries related to post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), (5) and since 2000, more than 347,962 veterans have suffered a form of TBI while on active duty. (6) However, not all TBIs are combat related. Recent TBI rates are nearly two times the rates reported for the Vietnam era. (7) Further, research on veterans from various wars has revealed that PTSD sometimes has a delayed onset, surfacing six months to forty years after the traumatic experience. (8)

   Historically, veterans have also faced issues of substance abuse, often in tandem with mental health issues, and these challenges continue today. Recent research has classified 43% of active duty military personnel as binge drinkers (9) and reported alcohol abuse rates as 40% for OIF/OEF veterans. (10) Steady and significant increases in alcohol abuse over a recent decade, 1998--2008, in military personnel has also been documented, specifically with increases from 15% to 20% in heavy drinking and 35% to 47% in binge drinking. (11) Regarding the co-occurring disorders of mental health and substance abuse, Vietnam veterans' dual experiences of PTSD and substance abuse has been well documented (12) with reported dual diagnosis rates reaching as high as 75% for that era's combat veterans with PTSD. (13) The relationships between mental health and substance abuse/addiction have been and currently are prevalent enough that self-medication through the abuse of alcohol, drugs, or both has been a clinically-recognized tendency of people with mental health issues for decades. (14) Furthermore, alcohol and prescription opioids have been named the "signature substances" of choice for OIF/OEF/OND veterans and military personnel. (15)

   Suicide, unemployment, homelessness, and incarceration are other serious issues facing veterans. These issues are often connected with each other and with the previously mentioned challenges and can vary by era. Due to an extensive variety of factors, there is no consensus regarding suicide rates among military veterans, and studies examining suicide in this population suffer many limitations. (16) However, there is consensus that suicide is a serious problem facing the veteran community. Indeed, it is so great a concern that the U.S. Department of Defense has recently taken an interest in the VTC movement, primarily based on the risk of suicide in the veteran population. (17) From 2001 to 2011, male Veterans Health Administration users had higher rates of suicide, and their rates maintained relatively constant in comparison to all U.S. males. (18) Estimates on the number of homeless veterans are also problematic. However, it has been estimated that 12,700 OIF/OEF/OND-era veterans were homeless in 2010, (19) and overall, approximately 47,725 veterans are homeless on a single night. (20) Finally, Gulf War-era veterans were unemployed at higher rates than nonveterans in 2013 and 2014. (21)

   As already noted, veterans can face a vast constellation of issues that may often be interconnected. Additional issues include reintegration into society, social support, and specific issues related to family. Findings indicate that the veteran population may have a higher prevalence of specific issues (e.g., mental health issues, reintegration, substance abuse) that have been shown to be related to illegal, violent, or hostile behavior. (22) These issues may put veterans at a higher risk for incarceration than the general population. (23)

   For example, PTSD and TBI have been shown to be highly prevalent in this population (e.g., designated as the signature injuries of OIF/OEF/OND veterans (24)), and anger and aggression constitute potential correlates of those conditions. (25) Additionally, self-medication is continually an issue. (26) These behavioral correlations may increase risk for contact with the criminal justice system.

   However, the actual number of veterans in contact with the criminal justice system is largely unknown. Information on veteran status is not routinely requested by agencies in the criminal justice system, and when it is collected, offenders may be reluctant to report military status because of the potential loss of benefits. (27) Although these studies are subject to the same concerns just noted, two recent studies have provided some insight into the number of incarcerated veterans. In 2009, 6.3% of a sample from the Maricopa County Jail inmate population identified as having served in the U.S. military. (28) In 2004, approximately 10% of state and federal prisoners had reported serving in the U.S. military, which is fewer than reported in previous years. (29) However, small percentages of these incarcerated veterans were from the OIF/OEF era (16% of Maricopa County inmates and 5% of state and federal inmates), (30) and the OND era had not yet begun. At the time, White and colleagues noted the context of their findings, anticipating a significant influx of veterans in the future. (31)

2. THE SPECIALIZED COURT MOVEMENT

   The second conceptual foundation of the VTC is the ongoing specialized court movement and its related research, which are of primary interest to the current study. The specialized court movement is predicated on the notions that specialized groups demand particular sets of services or responses that may not be readily accessible and that specialized courts are vehicles for connecting offenders to those services. The purpose of these specialized courts is to address the legal and extralegal problems of the offender, while still protecting the public. Traditional criminal courts aim to determine guilt or innocence. If the offender is found guilty, the responsibility to "correct" him lies primarily within the correctional system. Traditional criminal courts may impose other sanctions, such as restitution or community service, but the focus of those sanctions is to help restore society. This idea that specialized courts can directly help offenders coincides within several theoretical frameworks (e.g., therapeutic jurisprudence and restorative justice).

   Therapeutic jurisprudence holds that courtroom actions have therapeutic and nontherapeutic effects. (32) For example, the emotional well-being of the non-legal participants may be affected by the way they are treated by the legal actors. (33) Therefore, the court should adjust its actions to aid in the therapeutic process, while not compromising the principles of due process. (34) Certain principles and values, such as respect, dignity, noninvasiveness, and sense of community, are to be incorporated into the legal process.

   Restorative justice is an approach that aims to reintegrate offenders back into the community and make all parties whole by bringing offenders, victims, and community stakeholders together. Specifically, restorative justice calls for the following: (1) the community, victim, and offender to be voluntarily brought together; (2) an expanded focus from legal needs to also include extralegal needs and healing; (3) the shift from an adversarial proceeding to group conferences for reintegration; (4) the actions to be less punitive than traditional criminal courts; and (5) participants and stakeholders to feel restored. (35)

   Research has examined the existence of therapeutic jurisprudence in the specialized court system and...