By Anna Berry

Drug courts weren’t new to Audrey Clairmont. As a licensed social worker, she worked with a number of drug courts in the Boston area early on in her career  before she helped launch the drug court in Merrimack County in 2017.

So far, she’s found that there’s no New Hampshire advantage when it comes to a critical piece of the puzzle for successful diversion programs — resources.

“In Boston, if a client relapses, [they] get them into stabilization that day,” Clairmont says. “We just don’t have the infrastructure here for that and it’s unfortunate because the client is losing out.

“The criminal justice system is going to pick them up before we can. You know it’s an issue when it’s a relief to hear they got arrested — the alternative would have been worse.”

But despite significant hurdles, local treatment court leaders have made adaptations to a national model to help the programs grow in a state with limited government funding. As New Hampshire’s first drug court marks 15 years of operation, here’s a look at how problem-solving courts have been working on the ground, from innovations to roadblocks.

A Seat at the Table for Recovery Coaches

“When I was offered this [position], I said I wasn’t doing it without a recovery coach,” Clairmont recalls. “They’re such an integral part of what we do.”

A recovery coach is a non-clinical professional who supports a client diagnosed with substance misuse disorder. Many have personal experience in recovery and can become licensed by the state as certified recovery support workers with 46 hours of training, 500 hours of paid or volunteer work, and 25 supervision hours.

While most drug courts have a recovery coach available to participants as part of treatment, Clairmont decided to elevate the position to a core member of the team that meets at the courthouse each week. Although it’s not a practice that’s outlined in national standards, Statewide Drug Court Coordinator Alex Casale said Clairmont’s idea was innovative, and worth proposing to other counties.

According to the National Association of Drug Court Professionals, studies haven’t yet examined the impact of having community representatives such as peer mentors or sponsors on the drug court team beyond those representing law enforcement, the court system, and the treatment provider. However, “anecdotal reports suggest this practice can enhance team decision making and effectiveness,” the Adult Drug Court Best Practice Standards note.

Clairmont has found that the lived experiences of the program’s recovery coach, Reid Poosikian, create the best rapport with clients — “I think it’s critical to have [recovery coaches] on the team… they should always have an alliance with the client.”

Judge John Kissinger, who presides over the Merrimack County Drug Court and helped to found Keene’s program, also sees the benefits of giving recovery coaches more input.

“That’s a person who can really connect with the participants and relate their own experiences, which is a huge asset,” he says.

And, Christopher Ruggles, the first graduate of the Merrimack County Drug Court, agrees.

“Technically, I could pretty much say [the team members] were all my recovery coaches … but Reid and I have been to [AA] meetings before,” he says. “Having someone else who’s like you … [is] very important.”

Trauma-Informed Justice

Another idea that has been reshaping the criminal justice sector is integrating trauma-informed care.

According to the “Pedagogy of Trauma-Informed Lawyering,” research published by Temple University, “‘Trauma-informed practice’ is an increasingly prevalent approach in the delivery of therapeutic services, social and human services, and now legal practice. Put simply, the hallmarks of trauma-informed practice are when the practitioner puts the realities of the client’s trauma experiences at the forefront in engaging with the client, and adjusts the practice approach informed by the individual client’s trauma experience.”

New Hampshire data show that a significant number of adults — nearly 50 percent — have experienced childhood trauma. And, a 2018 report found a link between those experiences and adults who are now unhealthy or engaging in unhealthy behaviors, according to the “Health Indicators in Adults and Adverse Childhood Experiences (ACEs),” published by the NH Dept. of Health and Human Services.

For example: “the percentage of heavy drinkers who experienced ACEs (61 percent) was larger than the percentage among those who do not engage in heavy drinking (49 percent).” ACEs include verbal, physical or sexual abuse as well as neglect or dysfunctional family conditions or events such as mental illness, substance abuse, domestic violence or incarceration. ACEs have been linked to adverse health outcomes in adults, including depression, substance abuse, cardiovascular disease, and premature mortality, the report says.

“Close to 65 percent [of participants] have substantial trauma in their lives or in their backgrounds,” said NH Superior Court Chief Justice Tina Nadeau. “Dealing with that is important in addition to and in conjunction with the substance abuse disorder.”

Strafford County Attorney Tom Velardi, who oversees the 15-year-old drug court in the Strafford superior court, as well as the Rochester mental health program in the circuit court, says his programs have been moving to trauma-informed care.

“Sometimes what you think clients need is an incomplete picture … by ignoring the direct or vicarious trauma of the person receiving substance abuse treatment,” he says. “Step one is opening your eyes to this issue.”

Verlardi acknowledges that the approach “may seem obvious in hindsight.” In a Strafford County courtroom, for example, he says staff have talked about changing the room set-up — so treatment court participants aren’t anxious about having people at their backs — and improving interactions to make clients more comfortable and avoid re-traumatizing them.

“What can I do to make this a more supportive atmosphere while still holding each of these clients accountable?” Velardi says of the new thought process. “Can we be doing something better? No specialty court should do more harm than it does good.”

In Merrimack County, one example of using the trauma-informed approach happened when leaders made the decision two months ago to switch to a divided docket where women appear first in front of Judge Kissinger while the men wait outside.

“I’m very convinced that this helps the people who are survivors of trauma,” Kissinger says. “Female participants relate to team when they’re called up individually. They’re a lot more willing to talk about their circumstances and struggles …”

Indeed, almost every one of the four women in drug court on April 1 in Concord was forthcoming and open in front of the judge — sharing the good and the bad.

“I’ve definitely had some cravings,” one woman said. “Some days are worse than others … I’ve been able to work through it so far.”

Another woman was released from a residential treatment program three days before the court session.

“I did stay sober this weekend,” she said, beginning to cry. “The first couple days … that’s the hardest.”

The group of male participants, more than a dozen, more frequently had simple  “yes” or “no” answers for Judge Kissinger when they approached the bench.

Drug court leaders aren’t the only ones learning about trauma — Clairmont says participants learn more about their own experiences as the program progresses.

“Our clients have been so desensitized that they do not even really identify their experiences as traumatic when asked (likely because they are disassociating or using another defense mechanism),” she says.

If clients are asked in assessments whether they’ve experienced trauma, they often say no. But, if they’re asked, “Have you ever been assaulted, raped, threatened or witnessed something of the sort?” Clairmont says clients often say yes.

Additionally, she says clinicians are mindful when putting groups of participants together in a peer group —  “For example, if there is a woman with a significant trauma history with men and we have a male who has a history of DV [domestic violence] we will make sure to not put them together,” she says.

One of the groups, which provides evidenced-based curriculum for people with substance use disorder, is always divided by gender, allowing the clients to develop coping and stress management skills. With the right tools, they’ll be able to manage symptoms of trauma and ideally, become strong enough to do more in-depth trauma work down the road, Clarimont says.

On the Horizon: More Integration?

As the state’s treatment courts evolve, there’s always room to improve, especially when experts say the third wave of the country’s opioid epidemic — fentanyl — is cresting. While the number of overdoses in Manchester and Nashua dropped this spring, deaths from overdoses actually increased according to American Medical Response data. The state has received $35 million in federal funding over the past year to launch a new response system called “The Doorway.”

Many of the state’s most significant challenges, including treatment resources, housing and transportation, weighed on the minds of many drug court participants on April 1 in Concord.

Several of the participants who appeared in front of Judge Kissinger were traveling from sober homes and jobs miles away from Concord to their weekly court appearances. Many were desperately trying to get their drivers’ licenses back.

A new inductee who had been in the program less than a week was going back and forth to the court from Concord Hospital, where his newborn son was detoxing.

“I have $3 in my pocket,” said another man, biting his nails, who was looking for a bed in a residential program because his family’s patience was wearing thin. “Can I go back to work?”

With only one clean drug test to his record, he needed a full week of clean tests before Judge Kissinger would approve the request.

Another participant described anxiety and panic attacks as she wiped away tears — “That’s why I used.” She tried to calculate how she would make it to another check-in the next day and attend a courtroom session later that week to fulfill her sanctions for the week.

“Oh boy … oh boy,” she said under her breath. “Just getting a ride there…”

“I don’t want to make this impossible for you,” Judge Kissinger responded, adding that he wanted to give her credit for being honest about her substance use. “I’m glad you’re here.”

Ruggles, Merrimack County’s first graduate, says he was “very lucky” to have a family to count on but he frequently saw other drug court participants stumble in recovery because of homelessness. Now that he’s completed the program, he plans to lobby state lawmakers to support temporary housing for drug court participants.

“I know it’s a longshot, but I need to try,” he says. “They deserve a chance and living on the streets is a 100 percent losing battle.”

The lack of resources means second chances aren’t available to everyone. Of the approximately 1,000 felony charges a year in Merrimack County, Kissinger says drug court treats 60 to 70 people, or 6 to 7 percent.

“I think that it’s a great model but its only one part of the way that we need to address people with substance abuse disorder and mental health problems who are connected with the [justice system],” he says.

Velardi, the Strafford County Attorney, sees the need for better integration between the state’s mental health and drug courts. For one thing, he says it’s challenging to keep mental health courts running in the busy circuit court system, given the significant time judges must contribute to the program.

“We’re talking about the exact same issues,” Velardi says. “It continues to surprise me that we don’t have a more integrated approach which would deal with a client on a holistic basis …”

Blair Rowlett is the community supervision director for Strafford County Community Corrections and oversees the mental health court. The Strafford County-Rochester District Mental Health Court has had 76 graduates since it was established in 2007 and the program currently serves 15 participants.

Rowlett says the idea of a “general treatment court,” where high risk and low risk offenders are mixed, might not be right for some of her clients  — “Are they then victimized? I see some of my clients who would be very easily taken advantage of…”

While the county’s mental health court boasts a 20 percent recidivism rate for its graduates, the program remains a pilot project with time donated by team members and weekly half-hour court sessions dependent upon the schedule of one judge.

Rowlett and others are watching a new piece of legislation, SB 51, that will establish a commission to study the expansion of mental health courts statewide, as there are currently no mental health courts operating in Belknap, Carroll, Coos, and Sullivan counties.

Mental health court leaders are interested in establishing best practices because, unlike drug court, there are no national standards for mental health courts. Locally, there is also a need to gather statistics and measure success. The commission will submit a report on its findings before November 1, 2019.

Meanwhile, a 2016 independent review of the state’s child welfare agency recommended increasing the availability and reach of drug courts to better protect children at risk and to create more “meaningful” collaboration between DCYF and the court system. (See story on page 1).

Clairmont is already trying to better integrate families into her drug court.

She says she was encouraged at a recent national drug court training to think of her court as a “family drug court” and not solely a support for the person trying to get sober. Research shows that outcomes improve when an individual’s family is involved.

The Merrimack drug court now offers support groups for families and a class on sober parenting for drug court participants.

“The reality is that the populations are really the same,” she says. “Most of our clients have kids, have lost custody … and [are] struggling to parent. …

“Ideally we would add a family case manager — that seat at the table is missing.”

Inside the state’s oldest drug court in Strafford County, Velardi has turned to third and fourth chances for graduates who reenter the criminal justice system as the opioid crisis drags on.

“The longer you stay with the drug court, you’re more likely to see people trying it a second or third time … I think that surprises people,” he says. “You don’t ever know when someone will take the opportunity that’s presented through a specialty court.

“You remain hopeful that they take that opportunity to start down a path of wellness for themselves… [but] you’re still weighing out the risk of having this person out in the community.”

With a mix of optimism and pragmatism, Velardi takes the long view.

“It’s going to take us years to get out of this situation … months and years for people to heal and get well,” he says. “We need specialty courts now more than ever in the absence of any real concerted community treatment options … there’s still a long way to go.”

Anna Berry is the editor of publications for the Bar News, a member of the Granite State News Collaborative. (Disclosure: Berry’s spouse is a member of the steering committee for the Merrimack drug court.)