Treatment Court work is challenging, interesting, and rewarding. However, recovery is a long road, and it can take a long time before participants start to see lasting changes, as they work to acquire essential knowledge and skills. This can be frustrating for everyone. Frankly, all that listening that treatment court programming requires can get a bit, well, boring. What’s the best way to “supercharge” that process? Decades of research supports the Chinese proverb “I hear I forget, I see I remember, I do, and I understand.” The more we can engage participants not just through their brains but through doing, the more likely they are to understand, assimilate, and integrate recovery skills and knowledge. It’s not complicated: “Would you show me how you did that…” “Let’s practice that together…” and “Can you stand up and do…” are the kinds of prompts that ALL members of the team can integrate into their interactions with participants. While therapists are generally tasked with teaching participants essential recovery knowledge and skills, the entire team is responsible for helping to keep those skills active, to provide opportunities for practice and feedback, and to offer encouragement. The payoff is substantial, as research shows that infusing action into our encounters with participants boosts the acquisition of knowledge and use of skills.

The case for doing

Many treatment court participants experience memory, attention, and motivational challenges. Some have had negative school-related experiences earlier in life and may not learn well in a classroom context, which group work can sometimes mirror. “I hear” and “I see” are the comfortable, familiar educational strategies we typically rely on, as we talk and use handouts.  These telling (I hear…) and showing (“I see…) activities can be delivered in groups and seem time and energy-efficient. But that approach falls short for most of us. Consider CPR training. What part do you remember best? The lecture? Video? The multiple choice test? No; the hands-on practice on the manikin, right? If we think of our treatment work as empowering participants to “save” their own lives, the knowledge and skills we offer are akin to CPR. And best practice is to integrate action-oriented strategies that help ensure that the information is learned, retained, and used in everyday life.

Decades of research show that active learning (“I do”), in contrast to lecture and more passive modalities (“I see.., I hear…”), lead to better and longer lasting outcomes. This holds true not just for children, but for adults with substance use and/or mental health disorders (e.g. Mueser et al., 2002; Magill et al., 2020); and even for college students (e.g., Kozanitis & Nenciovici, 2022).  Albert Bandura’s Social Learning Theory (1977), holds that learning is a social, collaborative process. Observing and imitating the behaviors, attitudes, and emotional reactions of others are key to processing information and constructing our own realities. A positive, supportive atmosphere, repeated practice, and social praise are also essential.

Components of Active Learning:

Behavior change can be thought of as a two-phase process that involves first acquiring skills, and then applying those skills in the natural environment where it really counts.  To acquire the skills, participants have the opportunity to “see” the skill in action (modeling), role play (try out new knowledge and skills), practice, and receive feedback. To do this, we can draw from four social learning strategies:

1. Model the skills we want treatment court participants to learn (observational learning). Other program participants, members of the court team, peer recovery support specialists, and alumni can be powerful models of the attitudes and behavior we want participants to adopt.
2. Role play skills and information. Engage participants in brief interactions that require them to show what they know. Two example role playing prompts include: 
   1. “Pretend I am new to the treatment court program and have asked you ‘who do I need to talk to about looking for a job?’ How would you respond?”
   2. “You want to ask the judge if you can visit your daughter next week. Pretend I am the judge and show me how you would ask.”
3. Provide opportunities for repeated practice of applying knowledge/information and practicing new skills. This practice will allow participants to put their knowledge and skills into action over and over again, so it becomes routine. It will also be important for participants to practice with different people and in varied situations, so they become easily retrievable and implemented regardless of context. For example, have participants practice saying “no” to invitations that involve risky social situations, (e.g., a peer in active use wants to hang out; family gatherings that are highly stressful).
4. Give constructive feedback in real time that is specific, supportive, and offers the opportunity to apply it to improve.

Role play and repeated practice allow us to observe whether the participant has actually learned the knowledge and skills. But research shows that “knowing” is not enough. Results of studies using a “train and hope” model are discouraging (Stokes & Baer, 1977). Providing ample opportunities for participants to apply knowledge and skills in real-life contexts and receive real-time feedback is a best practice.

Once participants see and practice the skills and receive constructive feedback, decide if they are ready to try the behavior out in “real life” situations. articipants to practice their knowledge and skills in more natural situations and help them problem-solve any issues that may arise. Finally, they are ready to practice what they’ve learned on their own (homework).

5. In-vivo practice of skills, in natural settings, with support, prompts, and constructive feedback. This is an important step to assure that homework is feasible, as support and prompts are not present then.
6. Problem solving to identify obstacles tailor strategies to prepare for and combat them
7. Homework practicing the knowledge and skills independently, in daily life,

This table illustrates how these strategies can be used in spontaneous interactions with participants, and by ALL members of the treatment court team.

Homework is not a dirty word

Whether we call it “homework” or “out of session activities,” the science is clear that both quality and quantity of homework is associated with better post-treatment outcomes, including symptom reduction and relapse prevention (Katzantis et al., 2016).  Homework need not be pencil and paper; rather, it can be breathing, being in nature, dictating thoughts into one’s phone, or taking a photo. The key is to encourage the participant to bring some kind of evidence or report that it was done, and then provide praise and also problem solve for the future.

Who assigns homework? Not just treatment providers, but judges, defense attorneys, probation officers, case managers, court coordinators—all team members can ask “What are you learning in X? Show me…Pretend I am a new client, what would you tell me…” and so on. Homework can be done during case management sessions as a strategy for addressing criminogenic needs. For example, if a participant needs to establish a prosocial recovery network, assign homework to introduce themselves to a prosocial peer, or say “no” to an invitation to a high-risk social situation.

Why add more action into how you work with participants?  The cost is low, and the payoff is substantial. These evidence-based practices can make the treatment court experience feel more fresh, spontaneous, and meaningful.

Written by Sally MacKain, Ph.D., LP, NTCRC Director of Clinical Treatment, and Kristen DeVall, Ph.D., NTCRC Co-Director