Best Practices - Treatment and Rehabilitation for Driving While Impaired Offenders

3. Current Treatment Practice Issues (continued)

3.8 Offender payments

Key Points

• A variety of models for fee collection are used across Canada, with offenders paying service providers directly in some cases, while in others, program charges are included in relicensing fees.

3.8.1 Indications from the literature

A key issue in the provision of remedial programs for convicted impaired drivers is the funding of these services. A variety of models for fee collection are used across Canada, with offenders paying service providers directly in some cases, while in others, program charges are included in relicensing fees. A similar situation exists in the United States (Mann et al., 1997; Stoduto et al., 1998).

Some authors have proposed that there should be some consideration of financial hardship. Mann et al. (1997) recommended against such a policy in Canada, in part because costs were lower than in jurisdictions that had financial hardship provisions (mostly American jurisdictions), and because these costs themselves can serve as a deterrent to drinking and driving.

3.8.2 Key informant interviews

There was support from the majority (but not all) of the key informants that DWI screening/ assessment and education/treatment programs should be subject to some measure of cost recovery. Among key informants who supported cost recovery, there was broad support for cost recovery for assessments, but less support for offenders paying for DWI-specific education and treatment interventions. Several key informants raised the issue of clients with low incomes or living on social assistance being unable to pay. Fee payments by instalments were suggested by one key informant and several mentioned the need to keep payments at a reasonable level, otherwise it will deter participation. Key informants were also clear that the principle of cost recovery applied specifically to those services that focus on substance use and driving, and did not extend to addictions treatment services.

Generally, key informants supported payment of costs up front. However, the issue of whether paying up front might deter participation was raised by several key informants. One key informant indicated that in his jurisdiction, payment is not made until the client applies for licence reinstatement; he endorsed this as a method that increases the "show-rate" for assessment and intervention.

As noted earlier for education/treatment interventions, key informants recommended that cost-recovery measures be standardized between jurisdictions. Information on program costs, including those borne by program participants, is available in Section 6 of this report, Inventory of Canadian DWI Programs.

3.8.3 Best practices

The issue of who should pay for remedial programs has been addressed in several ways in different jurisdictions. However, over the years an emerging consensus has been that the clients should bear at least some of the costs for these services. This has occurred for several reasons, including constraints on public spending and an effort to reinforce the deterrent effect of an impaired driving conviction and associated costs. The key informants have indicated support for cost recovery for these remedial programs. It should be clarified, though, that costs recovered are for the DWI remedial programs specifically, and not for addictions treatment costs that may occur if individuals are referred to that system. Thus, it is recommended that costs for remedial programs for convicted impaired drivers be financed at least in part by user fees.

Program costs, in particular for longer or more intensive programs, can become expensive for offenders. The key informants indicated that it is important to find means to reduce the financial burden for offenders who may be assigned to more expensive program alternatives, or who lacked the financial resources to pay program costs. Several jurisdictions have introduced blended fees for offenders, where costs for all programs are covered by one set fee. While this may increase costs for clients who are in low-cost programs, it reduces the difficulties experienced in meeting fee requirements by those assigned to longer or more intensive programs, and it also allows more intensive programs to be introduced for those who may need them. Because treatment program fees are likely to be small in comparison with other costs associated with licence reinstatement (e.g. licence fees and increased insurance costs), these are not likely to be a major barrier to treatment engagement.

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Measures should be taken to reduce the financial burden for offenders, particularly those who are assigned to more expensive program options. This could include applying a single blended fee for all clients, or providing some form of financial assistance for low-income clients.

3.9 Program evaluation and research

Key Points

• Canadian researchers were among the first to document the risk associated with driving while impaired by alcohol and to provide information crucial to the development of successful remedial programs.
• Several influential evaluations of Canadian programs showed the remedial programs to be effective and stimulated further program development.
• There is a need for more extensive evaluation activities that can contribute to quality improvements, innovations and decisions about resource allocation.

3.9.1 Indications from the literature

Program evaluation encompasses a variety of activities and processes designed to show the extent to which programs are needed, are conceptually sound, are adequately resourced, are implemented as planned and are cost-effective. Evaluations provide information on the need for a program or program component, and can support accountability, program development and resource allocation decisions. Although closely related, when the primary aim of a program evaluation is to create new knowledge, it may be more properly referred to as research.

Canadian researchers were among the first to document the elevated crash risk associated with driving while impaired by alcohol and among individuals with alcohol use problems (e.g. Schmidt, Smart and Popham, 1963). They were also among the first to provide information on individuals convicted of a drinking-driving offence that proved crucial to the development of successful remedial programs for drinking drivers (e.g. Vingilis, 1983). Several influential evaluations of Canadian programs, conducted in the 1970s and 1980s, showed them to be effective and stimulated further program development (Health Canada, 1997; Mann et al., 1994; Vingilis, Adlam and Chung, 1981; Whitehead, Hulton and Markovsky, 1984; Zelhart, Schurr and Brown, 1975).

Evaluations of Canadian remedial measures programs have provided important insights into the ways these programs operate. In Manitoba and Alberta, evaluations have pointed to the effectiveness of programs in meeting needs of participants (Health Canada, 1997; Parsons, Wnek and Huebert, 1993). In Ontario, evaluations have demonstrated that the provincial program has been implemented with a high level of consistency and quality across 28 provider sites (e.g. Chipperfield and Mann, 2000; Shuggi et al., 2002) and that the assessment instrument used in the province demonstrates adequate psychometric properties (Flam-Zalcman, Chipperfield and Mann, 2002). In Quebec, evaluation research has described important characteristics of individuals who complete a program assessment (Boudreault, Brassard and Gagnon, 2002) and characteristics of individuals who are non-adherents in mandatory programs (Brown et al., 2002).

However, it is clear that evaluation has not been consistently supported over the years in this country. Frequently, programs have had few resources for evaluation activities, except those that generate basic information needed for program management. Programs have thus had to rely on external sources for funds to carry out other evaluation activities. This has not facilitated the kind of sustained evaluation activities necessary to ensure accountability, innovation and high quality programming.

3.9.2 Key informant interviews

In the context of describing programming in their jurisdictions, several key informants identified the need for evaluation, and the lack of resources to do this. There were several suggestions that the federal government should develop evaluation criteria that could be used across the country, and identify model Canadian programs. The need for more Canadian research was also expressed. Research on effective client matching tools, different assessment and treatment approaches, the effectiveness of education programs, research on programming for chronic repeat offenders and mandatory treatment were all mentioned.

Key informants generally agreed that DWI recidivism (as measured by incidents that come to the attention of the police, such as 24-hour suspensions and youth violating zero tolerance), and broad client outcomes should both be monitored. Several key informants identified the need to follow up with offenders after licence reinstatement. Several key informants also identified the need for research on offenders who do not apply for licence reinstatement and on the proportion who drive without a licence, and for how long.

Though key informants did not identify specific best practice mechanisms for quality enhancement, they did describe mechanisms in their own jurisdictions, which included using standardized assessment and interventions across a jurisdiction, monitoring program delivery in terms of wait times for assessment and program entry, regular program management meetings, and annual training.

3.9.3 Best practices

Program evaluation and research are necessary for program accountability, program development and rational resource allocation. Key informants have identified a strong need for program evaluation and research.

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Evaluation should be an integral part of any remedial measures program.

Funding for program evaluation and research has been very inconsistent over the years in this country. To maintain these activities, they should be supported on an ongoing basis as part of core program activities, and budgeted accordingly.

Best Practice 18
Program evaluation and research costs should be built into program budgets.

Basic program monitoring activities are generally common. However, key informants identified the need for more extensive evaluation activities that can contribute to quality improvements, innovations and decisions about resource allocation.

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More emphasis should be placed on quality assurance, and studies of the cost-effectiveness of programs and their component parts.