DOI: 10.5064/f6c8vuhp
title: Problem-Solving Courts, Street Level Bureaucrats, and Clients as Policy Agents in a Prostitution Diversion Program

description: &lt;h3&gt; Project Summary &lt;/h3&gt;

&lt;p&gt;&lt;strong&gt;Overview:&lt;/strong&gt; Over 3,200 problem-solving courts exist, with even more being planned, yet we know very little about how they work or about the extension of the drug court model to other types of offenses. Even less is known about the perspective of participants. This study examined prostitution models newly implemented in Baltimore City and Philadelphia, which, at the time, were two of the few existing examples of these programs that have been implemented with this population. It also included participant perspectives on what motivates them to participate in the program and how they negotiate with court professionals to meet their needs. This research study was designed to contribute to the broader policy debate regarding the risks and benefits of alternative criminal justice models, including under what circumstances and with which populations they are most likely to be effective, beneficial or harmful.&lt;/p&gt;

&lt;h3&gt;Data Overview&lt;/h3&gt;
&lt;p&gt;&lt;strong&gt;Study Design:&lt;/strong&gt; The study employed a primarily qualitative longitudinal design. Interviews and focus groups with a sample of Baltimore city’s Specialized Prostitution Diversion program (SPD) and Philadelphia’s Project Dawn Court clients that took place during and after their participation in the SPD or PDC, respectively, and with program staff and professional stakeholders, such as attorneys and probation officers. These were supplemented with observations of courtroom processes and interactions with program staff and quantitative analysis of data collected by the program, including participant demographics, program take-up and compliance rates, and types of services requested and provided. This builds on a pilot study of the SPD that included 25 interviews with 20 participants (5 were interviewed twice). While the PDC shares some traits with the SPD such as consequences of successful completion (null processing of cases), the PDC provides a useful comparison as it differs from the SPD along a number of program features that have been identified in the problem-solving court literature as salient, including length of program, level of judicial involvement, and the need to plead guilty in order to participate. This allowed for conceptual comparison of the two programs. These differences are important for this study as they may impact 1) client decisionmaking 2) professional stakeholders’ perceptions of clients, and 3) the negotiations between the two groups regarding program implementation and compliance.&lt;/p&gt;

&lt;p&gt;For further information on prostitution diversion programs and the study sites: &lt;/p&gt;
&lt;p&gt;• For an overview of key aspects of prostitution diversion programs, see: Shdaimah, C. (2020). Prostitution diversion programs. In Bernat, F.P. & Frailing, K. (Eds.), Women and Crime Encyclopedia, 3 volumes. Hoboken, NY: John Wiley & Sons Inc. Available at https://onlinelibrary.wiley.com/doi/10.1002/9781118929803.ewac0423&lt;/p&gt;
&lt;p&gt;• For more details on the PDC and SPD, including a comparison chart of key features, see:: Leon, C. & Shdaimah, C.S. (2012). JUSTifying Scrutiny: State power in prostitution diversion programs. Journal of Poverty, 16, 250-273.&lt;/p&gt;
&lt;p&gt;• For information on the backdrop and origins of Baltimore's SPD, see: Shdaimah, C.S. (2010) Taking a stand in a not-so-perfect world: What’s a critical supporter to do? University of Maryland Journal of Gender, Race, Class and Religion 10, (1), 89-111. &lt;/p&gt;
&lt;p&gt;• For information on the backdrop of prostitution processing in Philadelphia, see:
Baylson, M. (2017). Victim or criminal: Street-level prostitutes and the criminal justice system. In K. Hail-Jares, C. Shdaimah, & C. Leon (Eds.), Challenging perspectives on sreet-based sex work (pp. 156-161). Temple University Press.&lt;/p&gt;
&lt;p&gt;• For information on the PDC see the editorial remarks provided in:
Muraresku, L. (2017). “Just to be there”: A probation officer’s reflection on Project Dawn Court. In In K. Hail-Jares, C. Shdaimah, & C. Leon (Eds.), Challenging perspectives on street-based sex work, (p. 41-50). Temple University Press. &lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Study components:&lt;/strong&gt;&lt;/p&gt;

&lt;p&gt;1. Qualitative Interviews with Program Participants: A series of two to five interviews per person (depending on where they are at in the program) with participants in the SPD and PDC, during and after their participation in their respective program to explore their perceptions of that program and their encounters with professional staff. All PDC interviews were conducted by the PI, and SPD interviews were conducted primarily by Deborah Svoboda who at the time served as a PhD student research assistant. The interviews took place in a private location provided at the courthouse or of the respondent’s choice (these include quiet coffee shops, private rooms provided by programs that participants were enrolled in; participant homes and residential programs). Program staff referred most SPD respondents; most PDC respondents were recruited by the PI during court observations. In all cases, program staff were not informed of whether any particular individual participated in the study so as to avoid coercion. Basic demographic data were be collected as part of the interview, which otherwise comprised open-ended questions. In order to assist with follow up with the study participants, all study participants complete a locator form.&lt;/p&gt;
&lt;p&gt;We also explored concerns around trauma, substance abuse, and stigma by administering five brief standardized questionnaires once during the second interview, for descriptive purposes: &lt;/p&gt;
&lt;p&gt;• The Alcohol Severity Index-Lite (McLellan, Luborsky, Woody, & O'Brien, 1980).&lt;/p&gt;
&lt;p&gt;• The PTSD checklist- Civilian Version (PCL-C) (Weathers, F. W., Litz, B.T., Herman, B.T., Huska, J.A., & Keane, T. M., 1993)&lt;/p&gt;
&lt;p&gt;• The Stressful Life Experiences Screening (Stamm, et al., 1996)&lt;/p&gt;
&lt;p&gt;• The Trauma Symptom Checklist (Briere & Runtz, 1987)&lt;/p&gt;
&lt;p&gt;• The Internalized Shame Scale (Cook, 1987)&lt;/p&gt;
&lt;p&gt;Interviews lasting from 30-90 minutes were audiorecorded and transcribed verbatim.&lt;/p&gt;

&lt;p&gt;2. Qualitative Interviews with Program Staff and Professional Stakeholders: We conducted interviews with professional SPD and PDC stakeholders, including program social workers, public defenders, prosecutors, probation officers and judges. In both the SPD and the PDC, professional stakeholders from a number of different organizations were involved in the creation and implementation of the program for diverse motivations, and their beliefs about prostitution and about clients likely influenced the culture of the program and their interactions with and responses to clients. Interviews with these stakeholders explored their personal and professional beliefs, resources constraints, and the culture of constituent organizations. The interview guides included questions about their involvement in the SPD or PDC, respectively, their understanding of prostitution, and their views on clients generally and in specific cases. Interviews lasting 45-90 minutes were audiorecorded and transcribed verbatim.&lt;/p&gt;

&lt;p&gt;Interviews were semi-structured, meaning that the PI or GRA deviated from the questions to follow the lead of respondents. PDC interviews were much more free-ranging. While this may be a function of their being conducted by the PI who had more interview experience and felt more comfortable deviating from the questions, it largely derived from the longer term and multi-faceted relationships that formed due to the longer length of program participation in the PDC than SPD (minimum of one year and 90 days, respectively) as well as the shared interactions that took place during observations (see below).&lt;/p&gt;

&lt;p&gt;3. Observations: The PI and GRA conducted observations at the program site, which is Baltimore City’s East Side District Court and at Philadelphia’s Project Dawn Court. Both locations are where clients initially sign up for the program have their regular meetings with respective program staff. These observations provided a better sense of how the SPD and PDC work and program participants’ experiences. More importantly, they allowed the study of formal and informal interactions between clients and program staff, which will include negotiation around program implementation, individual treatment plans, and program infractions. No observations were conducted where heard privileged interactions between clients and their attorneys. Partway through the study, the protocol was amended to allow the PI to observation of public defenders’ interactions with prospective PDC clients at Philadelphia’s Riverside Correctional Facility (3 such observations were conducted). The PI also accompanied the second PDC probation officers on a “train-ride and walk along” observation to the primary site where PDC clients were arrested and, often, housed or attended required PDC activities; this observation including photographs. Another observation was conducted with the second probation officer while she met with probationers “in booth”. &lt;/p&gt;

&lt;p&gt;While observation data are not included in the database at this time, they provided an important source of rapport building and shared knowledge in the PDC site, where mandatory monthly court meetings and which the PI attended every month throughout the duration of the study for approximately 3-5 each time. Observations often led to questions during interviews and used as a means to gain insight into both the proceedings and respondents’ subjective experiences. The SPD had no such comparable requirement of venue where program participants and staff gathered, and so observations were made in general spaces where some participants may be present. For court observations, the PI chose to sit with program participants in the open court, although she was also invited to sit in the “jury box”. This was in order to allow for listening to and participating in informal conversation with program participants, and also to avoid perception that the PI was allayed the program staff or the program. The PI generally brought baked good to all hearings to distribute during breaks to program staff and participants. Notes were recording by hand or tablet when permitted by the bailiff. &lt;/p&gt;

&lt;p&gt;4. Focus Groups: We conducted one focus group each with SPD and PDC program participants. The collective group dynamic allowed for dialogue between group members, so that participants could hone and share their views through dialogue with others (Kruger, 1994). Focus groups were comprised of interview participants and other SPD and PDC participants. Focus group participants were not informed regarding whether others participated in interviews. Food and incentives were provided.&lt;/p&gt;

&lt;p&gt;While we also intended to collect SPD entry and exit documentation, these were not made available. We collected available, generic program materials, including forms that SPD participants were required to sign upon entry; the colloquy signed by PDC program participants, and other program materials such as program booklets from PDC graduation.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Recruitment and Sample:&lt;/strong&gt; All SPD and PDC participants were invited in person by program staff, the PI, or GRA to participate in the research using a recruitment script. When invited by staff, program participants were given the PIs contact information for follow up. All program staff were invited by the PI or GRA to participate in person or email invitation, also using recruitment script.&lt;/p&gt;

&lt;p&gt;Potential program participant respondents were informed that participation was voluntary and would in no way affect receipt of services or program participation. Staff were instructed to share study information at the end of their meetings with potential respondents, in order to convey that participation (or non-participation) would not impact receipt of services. This was reiterated to all referred participants before and during the consent process. &lt;/p&gt;

&lt;p&gt;In recruiting professional program staff, the PI and GRA emphasizes that their decision to participate was voluntary and that would not report to other staff members whether or not they participate. Where staff requested information or follow up to confirm study participation with supervisors, we provided requested information. Recruitment at both sites was cleared through gatekeepers. &lt;/p&gt;

&lt;p&gt;More information on the sample can be found in our published work. Interviews were held with 13 and 6 professional staff from the PDC and SPD, respectively. Eighteen PDC program participants were interviewed between 1 and 7 times; twelve SPD participants were interviewed between 1 and 4 times (one was deemed ineligible). One focus group each was held with PDC participants (N=8) and SPD participants (N=6). Demographic information, such as race and age were included in the interviews.&lt;/p&gt;

&lt;p&gt;Protection of Vulnerable Populations: The study also underwent IRB for vulnerable populations. These included under the federal category of “prisoners” due to study participants’ criminal justice involvement (probation, incarceration, court). The University of Maryland also considers individuals with PTSD as a protected category, and so the study was reviewed under this category of vulnerability. Literature on street-based sex workers who comprise the prostitution dockets in Baltimore and Philadelphia (corroborated in the Baltimore pilot study) have a high prevalence of trauma. As an additional precautions in this regard, Dr. Shelly Wiechelt of the University of Maryland, Baltimore County, who has expertise in substance abuse and trauma research and treatment, aided in creation of the research design. Steps taken to minimize risks to respondents who may be suffering from PTSD included:&lt;/p&gt;
&lt;p&gt;1. Short, standardized study instruments to assess trauma that are widely used to research-relevant information while not eliciting any detailed or specific information about traumatic events to reduces the likelihood of re-traumatization. Four of the 5 instruments were successfully used in prior research conducted by the PI and Professor Wiechelt with a similar study sample.&lt;/p&gt;
&lt;p&gt;2. Interviews and focus groups did not focus on past traumatic events but rather participants' experiences in the SPD/PDC. &lt;/p&gt;
&lt;p&gt;3. All participants were in ongoing counseling as part of their program requirements and therefore connected to supportive services which they could access if needed.&lt;/p&gt;
&lt;p&gt;4. The PI and GRA were prepared to immediately discontinue the interview and offer referrals for counseling if a participant became upset or distressed. They also brought a sheet with referral numbers and instructions relevant to each site/state so that they would prepared in the event of a disclosure of a participant's intent to harm herself or others (suicidality or homicidality).&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Study eligibility:&lt;/strong&gt; In addition to being a program participant or program staff all respondents were required to be over 18 (no minors) and proficient in English.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Compensation:&lt;/strong&gt; Professional stakeholders will receive no compensation for their participation in the study, nor did program participants who were observed but who do not participate in an interview or focus group.
Compensation was provided to all program participants at $20 per research activity (interview or focus group). The amount was designed to provide some compensation for time and effort but not unduly influence participation.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Consent:&lt;/strong&gt; At the outset of each portion for which consent is required (all interviews; focus groups; prison observations), the PI or GRA reviewed the potential risks and benefits of the study. Participants were informed that their participation is voluntary and they may end it at any time; program were informed that SPD/PDC services were not contingent upon participation or non-participation. Upon reviewing the consent form, the PI/GRA asked if the participant has any questions, then asked if the participant agrees to participate in the study. The person obtaining the consent signed and dated the consent document gave a copy to the study participants, who were also provided with the PI’s contact information to follow up with any questions or concerns.&lt;/p&gt;

&lt;p&gt;The consent form was written at a 7th grade reading level to make it comprehensible to individual with a wide range of education levels. The PI reviewed it aloud with participants, so that those who cannot read would not have to disclose this. The only portion of the consent form that was above a 7th grade level was wording required by the UMB IRB.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Confidentiality:&lt;/strong&gt;&lt;/p&gt;

&lt;p&gt;For all components of the study:&lt;/p&gt;
&lt;p&gt;1. Participants were asked to refrain from providing identifying information and all references to participants used pseudonyms that they chose. In the few instances where respondents did not provide a pseudonym, or provided a pseudonym that the PI was concerned would be deductively identifiable, pseudonyms were created by the PI.&lt;/p&gt;
&lt;p&gt;2. Identifying information provided inadvertently was removed or altered on transcripts. &lt;/p&gt;
&lt;p&gt;3. Participants were informed that the PI and GRA were required by law to report child abuse, adult abuse, or previous sexual abuse and therefore were specifically asked not to discuss these. Because answering whether a person has ever been abused would not elicit enough information to require a report according to the law in either state, we used standardized measures that asked this question without eliciting details.&lt;/p&gt;

&lt;p&gt;All respondents are referred to by their pseudonyms across all study data to allow for cross-referencing across data and published articles. Cross-referencing provides an integrated and comprehensive picture that includes stakeholder relationships within the two programs. It also rounds out and triangulates perspectives and data types by showing what people say about themselves, what others say about them, and their observed actions and interactions. In order to protect individuals who were not study respondents but were referred to by others, the PI changed these to psuedonyms unless they were public figures. Specific program names or locations, as well as certain identifying information such as exact ages were also altered for confidentiality purposes.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;For interviews:&lt;/strong&gt; Participant locator forms were shredded upon completion of final interviews.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;For focus groups:&lt;/strong&gt; Participants were asked to respect others’ confidentiality and refrain from discussing anything that came up in the focus group upon leaving the group.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Protection of Data:&lt;/strong&gt; Interview and focus group transcripts and audio files were stored on a password protected computer. Locator forms and consent forms, which were the only documents with identifying information, were stored in a locked file cabinet in the PIs office, which was locked when the PI or her research assistants were not in the office. Locator forms were destroyed upon completion of all relevant participant interviews. All transferred files were sent using the University’s secure transfer service (Accellion).&lt;/p&gt;

&lt;h3&gt;Data Analysis&lt;/h3&gt;
&lt;p&gt;A number of different methods were used to analyze the data for different purposes. For the initial analysis, qualitative data were analyzed to build and generate both descriptive analysis (Sandelowski, 2000) and to build theory (Charmaz, 2006), rather than starting out with a specific testable hypothesis (Padgett, 2008). In light of our limited knowledge of clients’ and professional stakeholders' experiences, this method was best suited to understand client and professional stakeholder perspectives on court-based interventions. This type of analysis can also point to further directions for research and is likely to flag connections and concerns that otherwise might not be readily apparent to policymakers and researchers. The constant comparative method of data analysis was employed to allow the researcher to revise the interview guides, if necessary, and for purposes of member checking with the same (due to the longitiudinal nature of the study) and others study participations. NVIVO qualitative data software was used to assist in the analysis. Initial analysis was conducted with peer groups comprised of the PI, Dr. Wiechelt, and different MSW and PhD research assistants. They performed independent coding initially and then created a combined coding scheme through dialogue, revision, and consensus, from the independent initial analyses in order to enhance rigor of the analysis (Padgett, 2008).&lt;/p&gt;

&lt;p&gt;Other forms of data analysis, included targeted secondary analysis, thematic analysis, and Saldana’s (2009) qualitative longitudinal matrices were used for different purposes, as described in relevant publications.&lt;/p&gt;

&lt;p&gt;In addition to member checking, peer debriefing, and prolonged engagement, study rigor was enhanced through triangulation of methods and sources.&lt;/p&gt;

&lt;p&gt;Scores from derived from the standardized measures were not used for clinical assessment purposes but instead to describe the participants' experiences of stressful life events, PTSD symptoms, trauma related symptoms, substance use behaviors, and shame. Descriptive statistics will be used to summarize the quantitative data. This information can be used to identify the complex treatment needs of SPD and PDC clients and provide direction to the court in the development of a service array. We compared their scores conceptually rather than statistically, due to the small sample size, with scores of the general population or sub-groups for which there is available data, such as for military populations for the PTSD measure.&lt;/p&gt;
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