Drug courts are a demonstrably effective strategy for increasing treatment retention and reducing drug use and criminal recidivism. In a time when PowerPoint images are used to augment everything from grade school presentations to congressional testimony, it is striking that similar visual aids have not been examined as a means to improve communication between drug court judges and clients in the court room. Building on our brief pilot work, this two-year study seeks to further develop a visual feedback procedure in drug courts and to examine its feasibility, acceptability, and preliminary efficacy. I this visual feedback procedure, line graphs depicting a client's longitudinal course of drug abstinence and treatment attendance is projected onto a large screen in the court room during their status hearing. The judge orients clients to the graphs and identifies positive and negative behaviors as well as patterns of behavior (e.g., monthly binges) using a laser pointer. In Phase 1, we will incorporate feedback from a visual learning consultant and from drug court staff and clients to finalize the visual feedback. In Phase 2 we will randomize 60 clients in equal proportions to attend their required monthly hearings with or without the visual feedback. All clients, as well as the judge and drug court team will complete regular assessments throughout this phase. In addition, we will conduct a structured focus group with the drug court team at the completion of the study. We hypothesize that the visual feedback procedure will be perceived by the judge and staff as both acceptable and feasible, and that it will result in better client outcomes (i.e., urinalysis-confirmed abstinence and treatment attendance) and greater perceptions of fairness (procedural justice), satisfaction with the program, and working alliance with the judge than hearings as usual. This represents the first research-based effort to improve communication and understanding between the drug court judge and clients through the use of visual feedback, and positive results could serve as the foundation for a fully powered study. Support for this visual feedback procedure has the potential to change the manner in which judicial status hearings are conducted in drug courts and other problem solving courts. The innovation of this study lies in its application of an age-old adage, """"""""a picture is worth a thousan words,"""""""" to improve the efficacy of drug courts.

Public Health Relevance

This two-year study seeks to further develop and examine the feasibility, acceptability, and preliminary efficacy of a visual feedback procedure to improve communication between the judge and clients in drug courts. In this procedure, the judge projects graphs of a client's progress on a large screen during their status hearing and uses them as a visual aid. Support for this visual feedback procedure has the potential to improve outcomes and to change the manner in which judicial status hearings are conducted in drug courts as well as other problem solving courts.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-RPIA-N (09))
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Wiley, Tisha R A
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Treatment Research Institute, Inc. (TRI)
United States
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Festinger, David S; Dugosh, Karen L; Della Porta, John M (2018) Examining the use of visual performance feedback in drug treatment court. Exp Clin Psychopharmacol 26:85-93