note: this document is designed to be a tool for your team in completing the application. it cannot be submitted in place of the online appli

NOTE: This document is designed to be a tool for your team in
completing the application. It CANNOT be submitted in place of the
online application.
Foundational Training: Adult Drug Court
Jurisdiction/Adult Drug Court (ADC) Info:
*1. Jurisdiction/Adult Drug Court Name:(*Required)
*2. Court Street Address:(*Required)
*3. City:(*Required)
*4. State:(*Required)
*5. Zip/Postal Code:(*Required)
*6. Point of Contact (POC) Work Phone:(*Required)
*7. POC Cell Phone:(*Required)
*8. POC Discipline:(*Required)
Geographic, Demographic and Court Info:
*9. What is the intended community (i.e., county, district, regional)
and the approximate population of the jurisdiction your adult drug
court will serve?(*Required)
*10. Which best describes your jurisdiction?(*Required)
Select one.

Rural (less than 50,000)

Urban

Suburban

Mixed
*11. Please indicate if any of the following drug court and/or problem
solving courts are operational within your jurisdiction.(*Required)
Select all that apply.

Drug Court
(Answer question number 11.1.)

DWI Court
(Answer question number 11.1.)

Mental Health Court
(Answer question number 11.1.)

None at this time
*11.1 Please enter the start date(s) of the other problem solving
court(s):(*Required)
*12. Has your court team previously participated in any drug, DWI,
mental health or veterans treatment court training(s)?(*Required)
Select one.

Yes
(Answer question number 12.1.)

No
12.1 If yes, please list all relevant training.
*13. Indicate your team's experience in adult, DWI, mental health or
veterans treatment court planning and exposure to the respective
concepts.(*Required)
Select one.

No experience or exposure

Limited (attended annual drug court, read articles)

Moderate (visited operational drug court)

Extensive (visited operational drug court, researched topic
extensively)

Completed planning and/or implemented pilot program or full docket
*14. Does your jurisdiction have a practice or policy in place to
examine whether unfair disparities exist for racial and ethnic
minority participants within the various court, treatment and social
service programs?(*Required)
Select one.

Yes
(Answer question number 14.1.)

No
*14.1 If yes, please describe the policy and explain the measures
taken to eliminate identified disparities.(*Required)
Criminal, Drug and Alcohol Data Collection:
*15. What are the top three drugs of choice for your clients?(*Required)
Select all that apply.

Alcohol

Cocaine/Crack Cocaine

Heroin

Marijuana

Methamphetamine

Prescription Medication

Other:
*16. Identify the specific drug and alcohol abuse patterns among
offenders in your community.(*Required)
Describe the adult offender population in your community by the
following categories:
*17. Race:(*Required)
*18. Ethnicity:(*Required)
*19. Age:(*Required)
*20. Gender:(*Required)
*21. Arrest Volume:(*Required)
*22. Crime Patterns: (include numbers and types of crimes)(*Required)
*23. Drug and Alcohol Use at Arrest:(*Required)
*24. Probation Violations/Violators Related to Drug and Alcohol Use:(*Required)
*25. Probation Violations/Violators Related to Mental Health Issues:(*Required)
*26. What percentage of the offender population are former or current
U.S. military service members (Army, Navy, Air Force, Marine Corps,
Coast Guard, Reserve or National Guard)?(*Required)
Criminal and Treatment Case Processing:
*27. How do you currently process cases in your court? Specifically
explain the process, including the average time frames, from moving a
person from arrest through disposition.(*Required)
*28. What challenges are experienced in the criminal case process from
arrest through disposition?(*Required)
*29. Describe the substance use disorder treatment referral process,
including time frames from intake and assessment, through
determination of level of care and assignment to a counselor.(*Required)
*30. Identify the challenges within the substance use disorder and
mental health treatment screening, referral, intake, screening and
assessment processes of offenders.(*Required)
Court and Program Information:
*31. How many participants are being or will be served in your adult
drug court (i.e. capacity)?(*Required)
*32. What validated criminogenic screen(s) and/or assessment(s) are
you using or plan to use?(*Required)
*33. What validated clinical screen(s) and/or assessment(s) are you
using or plan to use?(*Required)
*34. Is Medication Assisted Treatment (MAT) offered in the
jurisdiction?(*Required)
Select one.

Yes
(Answer question number 34.1.)

No
*34.1 If yes, please identify the medications available.(*Required)
Select all that apply.

buprenorphine

methadone

naltrexone
*35. Please identify and describe the existing court and probation
programs available in your jurisdictions for offenders.(*Required)
Statement of Intent:
All interested jurisdictions must provide responses to the following
questions. Narrative responses should be limited to 250 words.
*36. Describe the social, economic, geographic, cultural or industrial
conditions that you believe may contribute to drug and alcohol-related
crime in your jurisdiction.(*Required)
*37. Identify the type(s) of cases the adult drug court program
intends to serve (i.e. felony or misdemeanor, type and level of
offense).(*Required)
*38. Identify the mental health disorders often seen within the
offender population within your jurisdiction.(*Required)
*39. Describe the existing continuum of substance use treatment and
mental health services available in your community, including the
number of agencies that provide these services.(*Required)
*40. Describe the challenges of your current court/case processing
system and how the implementation of an adult drug court can help
resolve these issues.(*Required)
Team Information:
All interested jurisdictions must provide the name and contact
information of each team member to ensure the planning team is
comprised of the necessary individuals. Please note that the
disciplines listed are required to participate.
Judge
*41. Judge First and Last Name:(*Required)
*42. Phone:(*Required)
*43. Email:(*Required)
*44. How long has this person served in this capacity?(*Required)
Court Coordinator
*45. Court Coordinator First and Last Name:(*Required)
*46. Phone:(*Required)
*47. Email:(*Required)
*48. How long has this person served in this capacity?(*Required)
Prosecuting Attorney
*49. Prosecuting Attorney First and Last Name:(*Required)
*50. Phone:(*Required)
*51. Email:(*Required)
*52. How long has this person served in this capacity?(*Required)
Defense Attorney
*53. Defense Attorney First and Last Name:(*Required)
*54. Phone:(*Required)
*55. Email:(*Required)
*56. How long has this person served in this capacity?(*Required)
Treatment Provider
*57. Treatment Provider First and Last Name:(*Required)
*58. Phone:(*Required)
*59. Email:(*Required)
*60. How long has this person served in this capacity?(*Required)
Community Supervision
Pre-trial services, probation, parole, etc.
*61. Community Supervision First and Last Name:(*Required)
*62. Phone:(*Required)
*63. Email:(*Required)
*64. How long has this person served in this capacity?(*Required)
Law Enforcement
Does not include jail or prison correctional officers. Police
officers, sheriff's deputies and their equivalent from your local
jurisdiction.
*65. Law Enforcement First and Last Name:(*Required)
*66. Phone:(*Required)
*67. Email:(*Required)
*68. How long has this person served in this capacity?(*Required)
Evaluator
*69. Evaluator First and Last Name:(*Required)
*70. Phone:(*Required)
*71. Email:(*Required)
*72. How long has this person served in this capacity?(*Required)
Court Materials:
If your adult drug court is operational, please attach the documents
outlined below. Word Document or PDF are the preferred file types.
73. Policy and Procedures Manual:
74. Participant Handbook:
Additional Information:
If there is any additional information you feel would be important to
consider when reviewing your application, please feel free to add that
information here.
75. Additional Info:

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