Drug Treatment Court Participant Handbook (PDF)

DRUG TREATMENT COURT PARTICIPANT HANDBOOK

Court Address: 212 East Paw Paw Street, Paw Paw, MI 49079

Court Telephone: (269) 657-8200

VBC-0147 (11/4/20) Page 1 of 30 Table of Contents Introduction ...... 3 Mission Statement ...... 3 Vision Statement ...... 3 Welcome Letters from the Program Judges ...... 5 Our Goals = Your Goals ...... 7 Adjustments to Treatment ...... 7 The Drug Treatment Court Team ...... 8 Members of Your Team ...... 8 Attitude ...... 9 Honesty ...... 9 What are my responsibilities as a Drug Court Participant? ...... 9 Drug Court Program Rules ...... 9 Achievements and Incentives ...... 11 Sanctions ...... 11 We Celebrate Your Honesty, Strength, Determination ...... 12 and Ultimately Your Success ...... 12 Letters from Peer Support Specialists ...... 13 Appendix ...... 15 Appendix A: Drug Treatment Court Program Agreement ...... 15 Appendix B: Drug Treatment Court Phase 1 Requirements ...... 18 Appendix C: Drug Treatment Court Exchange of Information Release Authorization ...... 19 Appendix D: Drug Treatment Court Medication and Drug Testing Contract ...... 22 Appendix E: Drug Treatment Court Unsuccessful Discharge Behavior Agreement ...... 23 Appendix F: Drug Treatment Court Peer Support Specialist Behavior Agreement ...... 24 Appendix G: Drug Treatment Court Courtroom Behavior Agreement ...... 25 Appendix H: Specialty Court Notice of Prohibition Against Redisclosure ...... 26 Appendix I: Drug Treatment Court Prohibition of Ingredients Used to Manufacture Methamphetamine ...... 27 Appendix J: Drug Treatment Court Non-Discrimination Statement ...... 28 Appendix K: Drug Treatment Court Medical Emergency Agreement ...... 29

VBC-0147 (11/4/20) Page 2 of 30

Introduction

Welcome to the Van Buren County Drug Treatment Court! This handbook will help guide you through your time in the program. You are encouraged to share this handbook with your family and friends. We are excited to help you grow and commit to trying something new. Just be honest and trust the process and you will see amazing results. The program requirements may seem overwhelming at first, but once you get into a routine you will start to see the changes happening in your life. Do your best and trust that we are here for you every step of the way.

Mission Statement

To provide Van Buren County with cost-effective, evidence-based substance abuse treatment to rehabilitate lives, thereby reducing the strain on our legal system and alleviating taxpayer expense.

Vision Statement

The Van Buren County Treatment Court aims to transform lives from broken addicts to healthy, responsible, law-abiding citizens.

VBC-0147 (11/4/20) Page 3 of 30 Welcome! From the Judges

Van Buren County Court Judges Back row, left to right: Judge Jeffrey Dufon, Judge Michael McKay Front row, left to right: Judge Arthur Clarke, Judge Kathleen Brickley, Judge David DiStefano

Judge Kathleen Brickley Judge Michael McKay Women’s Drug Treatment Court Men’s Drug Treatment Court

VBC-0147 (11/4/20) Page 4 of 30 Welcome Letters from the Program Judges

KATHLEEN M. BRICKLEY FRANK HARDESTER Chief Judge Trial Court Administrator

MICHAEL T. MCKAY SUSAN ZUIDERVEEN District Court Judge SEVENTH DISTRICT COURT District Court Administrator

212 E. Paw Paw Street – Suite 220, Paw Paw, MI 49079 Phone: (269) 657-8225 ARTHUR H. CLARKE III Fax: (269) 657-7573 JAMES BECKER District Court Judge Magistrate 1007 E. Wells Street, South Haven, MI 49090 Phone: (269) 637-5258 Fax: (269) 639-4517 Email: [email protected]

Dear prospective participant, Welcome to the Van Buren County Drug Treatment Court. Our drug court is likely much different from any experience you had with the court system in the past. The most important word in the title of our court is “treatment”. There are many different reasons that people become addicted to drugs. One of the goals we have for you is to help you figure out why your drug use has become such a problem in your life – you probably don’t fully understand the answer at this point and that is okay. Through counseling, support and treatment we hope to help you figure yourself out and identify how to make your life better from this point forward. Making the change in your life to become and stay sober is not going to be easy. As the say goes, “If it were easy, everyone would do it.” Our program is challenging and there will be new standards because what you are trying to do to improve your life is hard, but not as hard as being addicted. Many people have gone before you in our program and succeeded in changing their lives – we want very much for you to be one of them. But, understand that success is not possible without your hard work and dedication. No amount of treatment or support can help you if you aren’t committed to changing your life. Work hard in the program and you can change your life for yourself and the people that are important to you. You control your destiny from here. We are here to help you get where you want to be.

VBC-0147 (11/4/20) Page 5 of 30 STATE OF MICHIGAN

212 Paw Paw Street, Suite 213 KATHLEEN M. BRICKLEY Paw Paw, MI 49079

Chief Judge PHONE: 269-657-8200, X2345 FAX: 269-657-2613 THIRTY-SIXTH JUDICIAL CIRCUIT COURT

Welcome to the Women’s Drug Treatment Court. You will find that you have just adopted a support system like no other. Whether it is the members of the drug court team or the other women in the program (who were where you are today), we are now your coaches, cheerleaders and family. We’ll be with you every step of the way and we look forward to your graduation and new life of recovery.

Some things you might want to know about us and the program:

1. We are realistic. We understand that you may or may not feel totally committed to recovery at this point. Some people choose drug court because they truly want to change their lives, and some choose it simply to avoid another outcome such as jail or prison. Many women who graduate tell us that they started out in that second group. They just wanted to get through the program so that they could go back to using. Once they took ownership of their own recovery though, and saw what their life could become, they never looked back. They now have their children in their lives, the trust of their families, new careers, degrees, and the confidence that comes with all that they’ve accomplished. So regardless of where you are now, we can get you to a better place.

2. Some days will be easier than others. No one on this planet demonstrates more dignity and strength on a daily basis than a recovering addict. This is hard work. You will probably make mistakes and possibly even use in the program. We know that, we expect that, we can help you with that. But if you can quit for a day you can quit for a lifetime so let’s start there. All we need from you right now is to show up and to tell the truth despite the mistakes you may make.

3. Your recovery comes first. This needs to be your number one priority in life. If your recovery does not come first, everything and everyone else you love in life will come last. Addiction makes you selfish which is not ok. But being selfish in your recovery is more than ok, especially right now. So don’t hesitate to set boundaries, to distance yourself from anyone who is using, to remove “friends” who are using from your phone and social media accounts, to skip a gathering that might be a trigger, or to take dating off your plate for the time being. This is YOUR time now.

4. People start using for a lot of different reasons. You may have had some really bad things happen to you in your life, or you may have made some bad mistakes, or you may not understand why your drug use has become such a problem in your life. Through counseling, support and treatment, we hope to help you find healthy ways to deal with your past and to find out who you really are. You can’t make a new beginning for your life, but you can start now toward making a new ending.

So, if you are ready and willing, you can change your life for yourself and for the people who are important to you. You control your destiny from here. We are here to help you get where you want to be. We believe in you.

Warmly,

Kathleen M. Brickley Circuit Court Judge

VBC-0147 (11/4/20) Page 6 of 30 Our Goals = Your Goals

You have the power to succeed here. You may have only wanted to enter this program in order to avoid jail time. You may not think that you have what it takes to stop using drugs and committing crimes on your own. You could be aware that you are in need of intervention because you are afraid of dying of an overdose. All of these reasons are good reasons to enter into drug court.

The Drug Court Team wants to help you by giving you the tools you need to be successful. We want to help you lead a successful, law abiding life, free from addiction. We value your choice to join this program. We know that this journey will not be easy and that there could be setbacks along the way. We believe that your willingness to actively work with this team using the tools of communication, courage, and honesty will lead to your success in this program. We want to celebrate with you in your victories and support you through any trials you may face.

Adjustments to Treatment

The Drug Court Team is here to closely monitor your progress throughout treatment and in recovery. If you are struggling to make progress, or within your recovery, the team may adjust your treatment plan with the assistance of your treatment providers.

In the event of a relapse following the completion of a phase, the team will reassess your current treatment plans and make adjustments as needed to ensure your success going forward. These adjustments are not to be looked at as a sanction but merely a way to help you reach your goals within the program and in your long-term sobriety.

VBC-0147 (11/4/20) Page 7 of 30 The Drug Treatment Court Team

Drug Treatment Court is split up by gender. Your treatment team will consist of a Case Manager, Program Coordinator, Probation Agent, Treatment Provider, Defense Attorney, Prosecutor, a Judge, and most importantly, You. The team is here to help you every step of the way.

This team of individuals works together to ensure that you have support, guidance, and the tools that you need to complete this program successfully. The members of the team all have different roles and will be a great resource to you.

Members of Your Team

Judge: The Drug Court Judge is the leader of the team. The Judge works together with the other members of the team in order to make decisions regarding admission into the program, incentives to celebrate success within the program, sanctions in order to adjust behaviors to ensure further success, and any other adjustments needed to aid in your journey to recovery. There will be status hearings where the Judge will discuss your progress or struggles within the program and work with you so that you are actively working towards your goals.

Case Manager: Your case manager will be an advocate for you throughout your entire journey. You will meet with your case manager to discuss progress and see how you’re doing in the program. Your case manager will be at every court session and can help answer any questions you may have.

Program Coordinator: The Program Coordinator is in charge of daily operation within the courts. Program Coordinators evaluate and ensure that your providers are giving the best services possible that will lead to the best result for you within the program.

Probation Agent: Probation agents check in with you and how you are doing in the community, at home, and with drug testing. Probation agents are there to report to the team your progress with your order of probation and to help you continue on the path to graduation from the program.

VBC-0147 (11/4/20) Page 8 of 30 Prosecutor: The drug court prosecutor helps to identify and select offenders who would make a good fit for the program. The prosecutor will obtain your prior criminal history and participate in team meetings. The prosecutor will also attend some court hearings with the team.

Defense Attorney: The defense attorney will make sure that your legal rights are protected. They will fully participate as a Drug Court team member and they will commit to making sure you are successful in the program.

Treatment Provider: Your providers assess your individual needs and provide treatment based on those needs. They will report to other members of the team on your progress. Treatment providers also advise the team of interventions and supports that will be valuable to your success in this program.

You: You are your greatest ally! You have the strength and determination to complete this program. Your number one responsibility is yourself. You must be willing to change in order to do so. You have taken a step today by enrolling in the program and your job is to be honest, real, and work together with the Drug Court Team. You are in charge of your attitude and how you do in this program. The team is here to support you all the way!

Attitude

When you made the choice to enter into this program you made an active commitment to change. The most important contributing factor to your success is your cooperation with the team through your attitude. We want you to succeed but most importantly you have to want that for yourself! Only you can change your life. It will take hard work to remain drug and alcohol free. Drug Court is here to support you so that you can live your best life. You are the most valuable part of your recovery! Your attitude determines the level of your success.

Honesty

Honesty is not just about not telling a lie. It is about being real with yourself and others. In this program, you must admit where you have been, where you are going, and believe in who you want to be. It will take courage and strength. There will be times when it all becomes too hard and you may fail, but the key is we expect there to be failure. Without failure we would never learn and grow. You must fail forward. Failing forward is where you acknowledge what happened, admit to the incident, and then actively seek to change the behaviors that led to the poor choice that was made. Your honesty to yourself and others will lead to success in this program. We are a team and are here for you!

What are my responsibilities as a Drug Court Participant?

Drug Court Program Rules

1. Always tell the truth Overcoming alcohol and or drug dependence is not easy, it takes a lot of hard work and dedication to change. The Drug Court Team / Judge will tell you the truth and expects that from you in return. Honesty is key to your success in this program!

VBC-0147 (11/4/20) Page 9 of 30 2. Totally abstain from the use of illegal drugs and alcohol This rule is key to your success in completing this program. You are required to obtain the approval of the Drug Treatment Court Team prior to using any prescription and/or over the counter medication. It is your responsibility to inform your treating physician(s) that you are a recovering addict and that you may not take narcotic, addictive, and/or mood-altering medications or drugs. You will also be instructed / encouraged to not associate with people who use or possess drugs.

3. Attend all treatment sessions as scheduled This includes individual and group counseling, educational sessions, and other treatment as directed. You must also come prepared with all necessary forms/paperwork needed for your appointments.

4. Be on time Be on time for court and treatment sessions. If you are late for treatment, you will not be allowed to participate and will be considered non-compliant. Contact your counselor if there is a possibility that you may be late.

5. Attend all scheduled Drug Court Sessions You must attend all court sessions as scheduled by the Drug Court case manager. As a participant, you are expected to dress appropriately for court. Inappropriate attire includes the following: t-shirts, undershirts, muscle shirts, halter tops, miniskirts, ball caps or hats (unless worn for religious purposes), clothing with advertisements, pictures or language pertaining to alcohol, drugs, and/or sexual or illegal behaviors.

6. Submit to Chemical Testing (Urinalysis, Breath Tests) as requested You will be tested for drugs/alcohol throughout the entire program. You will be tested frequently and randomly. It is your responsibility to arrive on time on your scheduled testing day prepared to submit your urine screen. Late, positive, or missed screens are all treated as positive screens. You have a responsibility to submit a valid urine screen. You are to ensure that your screen is not tampered with in any way. It should be noted that a positive test will not automatically terminate you from the program. The Judge will review your overall performance with the members of the Drug Treatment Court.

7. Do NOT make threats towards other participants or staff or behave in a violent manner Violent or inappropriate behavior will not be tolerated and will be reported to the court. You may not possess any weapons while in the Drug Treatment Court Program.

8. Maintain confidentiality of other Drug Court Participants Treatment cannot succeed unless all participants maintain confidentiality of other participants and of information disclosed during the treatment sessions.

9. Your Contact Information You are required to notify all members of the Drug Treatment Court Team of any change in your phone number and/or address prior to the actual change.

10. Employment / Education Requirements This may be accomplished by actively seeking or maintaining employment, attending school/job training, performing unpaid alternative community work assignments or other activities approved by your Drug Court Case Manager.

11. Abide by all other rules and regulations imposed by the Drug Court Team You are required to abide by all other rules and requirements as outlined in the Drug Court Participation Agreement.

VBC-0147 (11/4/20) Page 10 of 30 Achievements and Incentives

During your time in the Drug Treatment Program, your hard work and dedication to change will come with incentives. Incentives are rewards to celebrate the achievements you have made this far in the program. Achievements can come in many forms but here are a few examples of what success in this program may look like:  Successful completion of a phase of the program  Sobriety milestones  Obtaining employment  Enrolling in an educational program  Obtaining a GED  Restoration of your driving privileges  Participation in Drug Court Activities  Assisting other participants  Owning and taking leadership role in your treatment  Becoming a mentor  Following the program guidelines and rules

There are many incentives that can be earned but here are a few, including but not limited to:  Applause  Verbal praise from program staff  Accolades  Program fee discount  Free drug screen  Hazelden reading materials  Sobriety coins  Certificates of accomplishment  Gas cards  Early discharge from probation (probation violators)

Sanctions

Following the rules of the program will ensure your success. At times sanctions will be imposed as a way to modify behaviors that are not allowing you to move forward in this program. A sanction is not punishment. It is used to adjust behavior and allow you to make mistakes while encouraging you to move forward and to learn from those mistakes. Below is a list of violations of the program rules that could result in a sanction followed by a list of possible sanctions.

Examples of program violations that could lead to a sanction: • Missing court hearings • Missing drug testing • Dilute drug screenings • Tampering with drug/alcohol screening procedures • Positive for alcohol or drugs • Failure to attend case management meetings or treatment • Failure to respond to team in appropriate time frame • Being late for court • Failure to come prepared for meetings and court • Misuse of medications or taking unapproved medications • Unsuccessful discharge from the program • Dishonesty

VBC-0147 (11/4/20) Page 11 of 30 Possible sanctions, including, but not limited to: • Increased urine screens • Work alternative program • Curfew • Writing assignments and book reports • Increased court attendance • Increased reporting to case manager or probation officer • Community service • Incarceration • Phase extension • Daily reporting • Electronic monitoring

We Celebrate Your Honesty, Strength, Determination and Ultimately Your Success

You have read the handbook and now you might feel nervous, scared, and perhaps you are still considering if you have the strength to complete this program. Your success began the minute you decided to embark on this journey. You have made a life changing decision that will be difficult and at times you may feel like quitting. This handbook is designed to inspire you to see the changes that you have already made and the changes that you are capable of making. The Drug Court Team will be encouraging you and assisting you throughout the whole program. Your success is our success! We want you to ask questions, reach out when you struggle, and seek help at any time. Changing your thinking is not an easy process and will take hard work and dedication. In the beginning, the results may be slow coming but as you succeed you will begin to see that your honesty and hard work will pay off. We cannot wait to celebrate your success and we will be here when you struggle. Lastly, if you remain determined to change you will find strength you never knew you had. YOU CAN DO THIS! We are here for you!

VBC-0147 (11/4/20) Page 12 of 30 Letters from Peer Support Specialists

Here are some letters from people who will be of great support to your, our Peer Support Specialists

Hello My name is Nicole Aldrich and I am a Recovery Coach for the specialty courts here in Van Buren County. I graduated Drug Court in March 2015. I feel like the program gave me the opportunity to start my life all over. When I was released from jail back in 2013, I had nothing. My son was also put into the system. I was homeless… No job, no money, no vehicle… Nothing! I had hurt everyone I love and had little hope for the future. Drug court believed in me when I didn’t believe in myself. I had no idea how amazing life could be! I know that things can be overwhelming and maybe a little scary, but you are NOT alone!!! I will help you in any way I can. Please don’t hesitate to reach out :) No one is perfect, and we all have a past, but our future is up to us. The struggle is real! You have an amazing team of people fighting for you though. Don’t be afraid to be honest with them, they really do care. I hope to hear from you soon :)

You can do this…Just keep swimming!

Nicole 269-312-0158

VBC-0147 (11/4/20) Page 13 of 30 Your Journey Begins Here!

Hello!

My name is Jewel Dailey and I am honored to be one of the peer recovery mentors for the Van Buren County Specialty Courts.

I would like to welcome you into the program that saved my life.

From my first hit I became an addict. I was using to live, and living to use, just to mask childhood trauma because I never knew how to cope- I was just too scared and angry at the world. I became a thief, my home was often raided, and I found myself in the courts multiple times on probation, with CPS involvement, I was on the run continuously and by doing so I was holding on to being a victim and avoiding my responsibilities of becoming a survivor. It seemed so much easier to stay on that sick, comfortable path that I had known for so long. I was scared of change and failure, but I knew I was going to die if there was not some sort of intervention. Thank God, that in November 2010 the Van Buren County Drug Treatment Court was my opportunity forward into restoration.

Through the program I have come to terms with the fact that I was hurting myself and that my children, who needed me to protect the, were caught in the crossfire. In all reality I struggled for many years on how change was possible. Addiction promised me jail, admission into institutions and on occasions I nearly died. I was still unsure but deep down I wanted to find my purpose. I was hoping and praying that there was more than the life I had been living. I turned my struggles into strength and let that be my motivation for change.

This program helped me every step of the way. As the employees of the program got to know me as an individual, with my unique struggles and my strengths, they guided me on a path to recovery. They connected me to a beautiful soul who counseled me, inspired me to overcome my deepest struggles and held me accountable, most importantly to myself. So many times, I wanted to give up, but they all kept pushing me along because they had faith in me. I can still hear the Judge telling me how they believed in me.

Those powerful words were an encouragement to not give up. Often, I wanted to quit, but because they helped me to see what I was capable of, they truly guided me in my work to success. Yes, I say guided, because I had to make up my mind to do some extremely hard work. But it was, and is, so worth it: I am a mother to my children, I have my own home; the program’s other resources have helped me, who was an 8th grad dropout, receive my GED, and my Driver’s License. Additionally, I am now certified through the State of Michigan as a peer support mentor.

These days I work with the treatment courts as well as directing my own program of recovery, as founder of The Daily Recovery Zone, a local, non-profit organization. We are definitely a strong team to have in your corner on your own path to recovery. I will walk with you every step of the way. I hope to become your biggest supporter and fan.

I am blessed to have found my purpose, and if I can do it, you can do it too!

Sincerely,

Jewel Dailey CPRM M-00100

VBC-0147 (11/4/20) Page 14 of 30 Appendix Here you will find the admission forms that you will need to fill out in order to enter the program. Below we have given a brief outline of what the purpose of each form is Appendix A: Drug Treatment Court Program Agreement

The Drug Treatment Court Program Agreement (form VBC-0113) will guide you through the rules of the program and outline your responsibilities to the program and yourself. The program staff and you will sign this agreement upon entry into the program and the form is included in this handbook for your review at any time, refer back to it often so you are reminded of what you have agreed to accomplish through the program. This document functions as a contract between you and the program. Here you will find the dos and don’ts of the program. This is the most important form to ensure your success! The bottom of the agreement is important as it is a reminder of key points that you have agreed to above and outlines further certain important facts, there is also an agreement of the role of the program staff. Below is a copy of the form:

DRUG TREATMENT COURT PROGRAM AGREEMENT

Court Address Court Telephone No. 212 E. Paw Paw Street, Paw Paw, MI 49079 (269) 657-8200

Defendant/Probationer/Parolee: Charge:

The above defendant will be accepted into the Van Buren County Drug Treatment Court program if they agree to the rules and conditions of the program set forth below OR: the above Probationer/Parolee has been ordered into the Van Buren County Drug Treatment Court program and must adhere to the conditions and rules of the program set forth below. If the defendant commits a violation of any of the conditions listed below, they may be terminated from the program and confined to the Van Buren County Jail. If the defendant completes the program satisfactorily, they will be discharged from the program and no further action will be pursued.

APPLICANT’S STATEMENT: I agree to abide by the terms and conditions of the program set forth below. I understand that: A. If I am a diversion client, the Prosecuting Attorney, program Judge, or I may terminate this agreement at any time, and I may be confined in the Van Buren County Jail. B. If I am on Circuit or District Court Probation or Circuit Court Parole, my agent may also terminate this agreement, but I cannot terminate my participation in the program. Therefore, I agree to: 1. Complete any evaluations or assessments as directed by the drug treatment court and follow the recommendations thereof. The treatment recommendations will be shared with the drug treatment court team. 2. Work with treatment staff to develop a treatment plan and follow the plan accordingly, including aftercare and continuing care recommendations. 3. Not violate any criminal law of any unit of government. 4. Immediately notify the case manager of any police contact, arrest or criminal charges within 24 hours of event or release from jail. 5. Immediately notify the case manager of any phone number changes within 24 hours. 6. Must have approval prior to moving or to a new address. 7. Make full and truthful reports to all program staff. 8. Not engage in any assaultive, aggressive, threatening or intimidating behavior. 9. Comply with all conditions set forth during my case management appointments. 10. Attend all program requirements on time as directed by program staff. If I fail to attend a scheduled appointment, I understand that I will be responsible for paying a “no-show” fee and may be sanctioned by the court. If I am unable to attend a scheduled appointment, I will reschedule the appointment at least 24 hours in advance. 11. Appear in court on all scheduled court dates and to attend all appointments with my probation office and case manager.

VBC-0147 (11/4/20) Page 15 of 30 12. Not leave the state without consent of the case manager. I understand that if I am on probation, I must also have the consent of my probation officer. Participants not on Circuit Court probation may travel outside the State of Michigan only for a verified emergency or other legitimate purpose such as school, work, court, or family obligation. Requests that are solely for recreational purposes will not be approved unless the activity will contribute to the participant’s ability to successfully complete the program. Travel outside the United States is prohibited. 13. Submit to PBT’s, electronic monitoring, and other drug/alcohol urinalysis or testing. The frequency is determined by the program staff or at the request of another officer of the court. 14. Follow up with all referrals that program staff determines will assist me in maintaining sobriety and a law-abiding lifestyle in the community. 15. Be employed or enrolled in an educational program or participate in another positive activity as directed. Immediately notify the case manager of any employment or education changes within 24 hours. Termination from any employment or education institution may result in a sanction depending on the circumstances surrounding the termination. 16. Pay all court ordered fines and costs, including minimum state costs, the drug treatment court fee, crime victims’ rights assessments, and restitution resulting for my conviction, in order to successfully complete the program. I will also pay all, or make substantial contributions towards payment of, the costs of treatment and drug treatment court program services provided to me, including, but not limited to, the costs of urinalysis and such testing or any counseling provided. However, if the court determines that the payment of fines, the fee, or costs of treatment would be a substantial hardship for me or would interfere with my treatment, the court may waive all or part of those fines, the fee, or costs of treatment per MCL 600.1074 (1) and (3) 17. Attend recovery support meetings as indicated by my phase in order to maintain my sobriety. Attendance at support meetings will be verified and confirmation will be presented at case management meetings. 18. Reimburse the jail for incarceration resulting from my participation in the program. 19. Authorize program staff to contact any or all parties involved in the reconciliation of restitution involved in pertinent cases. I also understand that I will not be successfully discharged until restitution is paid in full. 20. Abstain from using alcohol, including any substance that contains alcohol. 21. Abstain from consuming any designer drugs such as Spice, Bath Salts, Kratom, or other chemically altered substances. This includes any substance labeled or marketed as “Not for Human Consumption”. 22. Abstain from unapproved prescriptions or unapproved over the counter medications. I understand that I must have prior permission from my case manager before consuming any medication. Ultimately, I agree to abstain from any mood-altering substance while in the program. 23. Not be in possession of any controlled substances, drugs, drug paraphernalia or medications prescribed to another party. 24. Immediately report any drug or alcohol use to my case manager, understanding that my sanction in court will increase if I choose to be dishonest. 25. Not to enter an establishment whose primary purpose is to sell or dispense alcohol or illegal drugs for consumption on the premises. Also, not to enter an establishment that sells or dispenses medical or recreational marijuana. 26. You must not enter any casino or other establishment where gambling is the primary purpose (e.g. horse racetracks, off-track betting establishments). 27. Not to use any object as a weapon. You must not own, use, or have under your control or area of control a weapon of any type or any imitation of a weapon. You must not be in the company of anyone you know to possess these items.

PAYMENT AGREEMENT There is a $25 monthly fee charged to all Drug Treatment Court participants which goes towards some of the cost of the program. The payments must be in the form of exact cash or a money order and is accepted at the County Clerk’s office. All participants are required to pay $5 for every drug test and $30 for lab confirmations due to denied use or THC level checks.

I waive the following rights:

1. The right to a speedy trial. 2. The right to representation by an attorney at the review hearings. I still maintain the right to an attorney for any program violation or probation violation where the facts are contested and a liberty interest is at stake, or if I may be terminated from the drug treatment court program. 3. With the agreement of the prosecutor, the right to a preliminary hearing. 4. To be present at the team staffing meetings.

I understand that:

VBC-0147 (11/4/20) Page 16 of 30 1. The drug treatment court program has a minimum duration of 15 months. 2. If I am convicted of a felony for an offense that occurred after I am admitted to drug treatment court, the judge must terminate my participation in the program per MCL 600.1074. 3. I understand I am required to attend all appointments for court, treatment, ancillary services, and all drug and alcohol testing as scheduled. 4. I understand that drug treatment court staff may make unscheduled home visits, and I will allow drug treatment court team members, together with law enforcement officials if accompanied, into my home at any time for supervision or compliance reasons. 5. Review hearings are held in open and public courtrooms, and although the court attempts to minimize confidential information in court, it is possible that an observer could connect a participant’s identity with the fact that he or she is in treatment as a condition of participation in the drug treatment court or that confidential information may be revealed. 6. Staffing meetings, which are held before review hearings, are typically closed to the public. Confidential information may be discussed by the drug treatment court team members at a staffing meeting. I understand that if a nonteam member is invited to participate in a staffing meeting, they must sign a confidentiality agreement and receive my consent prior to observation. I understand that participants will not be present at staffing meetings. 7. The data in my public and confidential file may be used for research, data analysis and program evaluation by the drug treatment court, court staff, or individuals or others independent of the drug treatment court. Any data used in this way will be de-identified prior to distribution. 8. Failure to fully comply with all the terms and conditions of the program listed above may result in the following: • Notification to the judge that I am in violation of the program. • If I admit guilt to or am found guilty of a program violation; then sanctions, up to and including jail, may be imposed or additional conditions may be added as determined by the judge with input from the drug treatment court team. • Termination from the program. 9. I understand that if I am discharged from drug treatment court, I may request that a judge, other than the drug treatment court judge, sentence me on the underlying charge. 10. I understand that the drug treatment court may amend these conditions and/or add new conditions, notice of which will be provided to me in writing. I understand that I must comply with the amended or added conditions.

The drug treatment court agrees to:

1. Meet with the program participant as needed to help assure successful completion in the program. 2. Report the participant’s progress and test results to the court. 3. Refer the participant to any community agency at the drug treatment court’s disposal which may assist in the participant's recovery.

I have discussed the above listed conditions with my attorney or the drug treatment court

Participant Signature Date

Drug Treatment Court Signature Date

VBC-0113 (6/3/20)

VBC-0147 (11/4/20) Page 17 of 30 Appendix B: Drug Treatment Court Phase 1 Requirements

The Program has five phases, in order for you to move through phase 1, you must complete all the requirements listed on the Drug Treatment Court Phase 1 Requirements (form VBC-0124). When you sign this form, you are stating that you understand what is expected of you. It could be helpful to place this information in a planner to ensure that you remember important appointments. Below is a copy of the form:

DRUG TREATMENT COURT PHASE 1 REQUIREMENTS

Court Address Court Telephone No. 212 E. Paw Paw Street – Suite LL001, Paw Paw, MI 49079 (269) 657-8200

I , understand and agree to maintain the following Phase 1 requirements:

URINE SCREENS: • I must submit random urine specimens as directed. • I understand that I need to call (269) 459-7910 everyday, including weekends and holidays, and will provide a urine specimen as instructed by the message. • If not employed full time, I am required to provide a urine specimen one hour prior to the end time stated on the daily recording. • I must have 14 consecutive days of sober time as demonstrated by drug testing, which begins after the first confirmed negative test. • Missed testing, failure to produce a sample, and dilute samples will be treated as a positive test.

TREATMENT: • Call 800-781-0353 for a substance abuse assessment at the Van Buren County Mental Health by or schedule with a private provider by . Date Date

PEER SUPPORT SPECIALIST: • Make contact with the assigned Peer Support Specialist as directed.

SUPPORT GROUP MEETINGS: • If applicable, attend support group meetings as directed by treatment provider or peer support specialist.

CASE MANAGEMENT APPOINTMENTS: • Attend appointments with my case manager as directed, beginning on at Date Time • Develop individualized case plan

DRUG COURT: • Attend Drug court every two weeks beginning on . Date Note: It is your responsibility to schedule or cancel appointments. Rescheduling and / or canceling an appointment must be done 24 hours in advance or a no-show fee may be charged to you. Failure to attend scheduled appointments, without canceling and rescheduling, will be subject to sanctions as agreed upon in your participant agreement.

If I have any questions about program requirements, I will call my case manager. If I am unable to speak to my case manager directly, I will leave a message and my call will be returned as soon as possible.

Client’s Signature Date

VBC-0124 (10/4/19)

VBC-0147 (11/4/20) Page 18 of 30 Appendix C: Drug Treatment Court Exchange of Information Release Authorization

The Drug Treatment Court Exchange of Information Release Authorization (form VBC-0127) is used to allow the program staff to communicate with other members of your treatment team about your confidential information. It gives your case manager access to information about your treatment, drug test results, and your progress within the program, as well as allows them to communicate with other members of the team to ensure that you are getting the best care possible. The names of those that information will be shared with are listed here and the types of information that will be shared is listed as well. Your signature ensures the release of this information for 90 days after treatment has ended to those listed. Below is a copy of the form:

DRUG TREATMENT COURT EXCHANGE OF INFORMATION RELEASE AUTHORIZATION

Court Address Court Telephone No. 212 E. Paw Paw Street, Paw Paw, MI 49079 (269) 657-8200

Last Name: First Name: Date of Birth: Social Security Number:

I am currently: on bond on probation/parole

A. EXCHANGE OF INFORMATION I understand that my participation in the Drug Treatment Court is a condition of my probation, parole, bond, or the disposition of any criminal proceedings against me. I hereby request and authorize the exchange of information about my treatment, drug test results, and participation in the program between the Drug Treatment Court Staff and the individuals and/or organizations listed below. I authorize this exchange of information only under the conditions listed below:

Name of person(s), organizations to whom the disclosure is to be made if they are involved in my case: • All Van Buren County Courts • Van Buren Adult Education • Office of Community Corrections • Van Buren Intermediate School District • Office of the Prosecuting Attorney • Michigan Rehabilitation Services • Defense Attorney Services • MIWORKS • Michigan Department of Corrections • Michigan Prison Reentry Initiative • Law Enforcement Agencies • Cordant Labs • All DHS services involved with my case • State Court Administrative Office • Community Mental Health • ACT Innovations • Health Department • Electronic Monitoring Agencies • Community Healing Center • Ignition Interlock Agencies • Jim Gilmore Jr. Treatment Center • Michigan Secretary of State • Mapleview • Medication Assisted Treatment Agencies • KPEP Any additional agencies:

If information is authorized to be released to a party under a general designation, the participant (or other individual authorized to sign in lieu of the participant), understands that, upon request and consistent with this part, the Van Buren County DTC program will provide a list of entities to which their information has been disclosed pursuant to the general designation (see § 2.13(d)).

VBC-0147 (11/4/20) Page 19 of 30 B. INFORMATION TO BE SHARED 1. Name, address, and other personal identifying information of the participant. 2. Van Buren County DTC program assessments. 3. Van Buren County DTC program behavior summaries and updates. 4. Treatment information, including assessments, attendance, progress and compliance reports, treatment plans and discharge summaries. 5. Drug and alcohol screening, testing, confirmation results, and payment information. 6. Health information. 7. Reportable communicable disease information, including HIV, sexually transmitted infections, hepatitis, and tuberculosis. 8. Health plan or health benefits information. 9. Electronic monitoring information, including compliance and payment information. 10. Other (specify, if any):

Note: I authorize all the above information to be shared unless I indicate here. Please list the number of each category of information you do not want shared:

C. PURPOSE OF USE AND DISCLOSURE The purposes for the disclosures authorized by this form are: 1. To assess if the participant needs substance use, mental health, or developmental disabilities services and treatment. 2. To provide, manage, and coordinate Van Buren County DTC program and substance use, mental health, and developmental disabilities services and treatment for the participant. 3. To develop a Person-Centered Plan, Service Plan, and/or Treatment Plan for the participant. 4. To make dispositional recommendations for a court-involved participant. 5. To monitor payment for services and establish financial assistance if determined necessary. 6. To improve service and treatment outcomes for participants involved in the Van Buren DTC program. 7. Other (please specify):

D. REDISCLOSURE AND CONFIDENTIALITY Once health care information is disclosed pursuant to this signed authorization, I understand that the federal health privacy law (45 CFR, Parts 160 and 164) protecting health information may not apply to the recipient of the information and, therefore, may not prohibit the recipient from redisclosing information to others. However, substance-abuse treatment information protected by federal law (42 CFR, Part 2), shall remain confidential and must not be redisclosed by the recipient except as authorized by those laws or this authorization. The federal rules restrict any use of this information to criminally investigate or prosecute any alcohol or drug abuse patient.

E. CONSENT EXPIRATION This consent shall expire 90 days after participation in the Van Buren County DTC program ends.

F. CONFIDENTIALITY RIGHTS Federal law protects the confidentiality of treatment records under 42 CFR, Section 2.1 through Section 2.67; and Section 290dd-2. This means that: 1. Treatment information is ordinarily kept confidential. 2. Review hearings are held in open and public courtrooms, and although the court attempts to minimize confidential information in court, it is possible that an observer could connect a participant’s identity with the fact that he or she is in treatment as a condition of participation in the Van Buren County DTC program or that confidential information may be revealed. I specifically consent to a potential disclosure to third persons.

VBC-0147 (11/4/20) Page 20 of 30 3. Staffing meetings, which are held before review hearings, are typically closed to the public. Confidential information may be discussed by the Van Buren County DTC team members at a staffing meeting. I understand that if a non-team member is invited to participate in a staffing meeting, they must receive my consent prior to observation. 4. If I refuse to consent to disclosure or attempt to revoke my consent prior to the expiration of this consent such action is grounds for immediate termination from the Van Buren County DTC program. 5. It is a crime to violate confidentiality requirements, and the participant may report such violations to Michigan's attorney general at 517-373-1110. 6. Notwithstanding this confidentiality requirement, covered information may be released under specified circumstances and may include medical emergency, crimes on the premises, crimes against staff, administration/qualified service providers working with the Van Buren County DTC program, and outside auditors, central registries and researchers. 7. Federal law does not protect information relating to the abuse or neglect of a child, state child abuse laws, court orders signed pursuant to 42 CFR part 2 for release of specific information, state laws relating to cause of death and duty to protect others, and to warn of serious imminent harm.

I acknowledge that I have been advised of my rights, have received a copy of the advisement, and have had the benefit of legal counsel or have voluntarily waived the right to an attorney. I am not under the influence of drugs or alcohol. I fully understand my rights and I am signing this consent voluntarily.

SIGNATURE CONSENTING TO RELEASE OF INFORMATION

Participant signature Date

Staff witness signature Date

Staff witness printed name

VBC-0127 (8/20/19)

VBC-0147 (11/4/20) Page 21 of 30 Appendix D: Drug Treatment Court Medication and Drug Testing Contract

The Drug Treatment Court Medication and Drug Testing Contract (form VBC-0117) states that you agree to not use certain medication while in the program and that you agree to test in an honest and acceptable manner for the court. The document outlines your responsibilities in testing and in the use of all types of medication while in the program. Your signature is your agreement to testing and the use of medication. Below is a copy of the form:

DRUG TREATMENT COURT MEDICATION AND DRUG TESTING CONTRACT

Court Address Court Telephone No. 212 E. Paw Paw Street – Suite LL101, Paw Paw, MI 49079 (269) 657-8200

MEDICATION POLICY • I understand that I must have permission from the Drug Treatment Court Program staff before consuming any medications, prescribed or over the counter. • I agree to not consume products containing any THC, alcohol, herbal products, vitamins, over-the-counter substances, poppy seeds or diet products. You are responsible for everything you put in your body. • I understand that it is my responsibility to read labels and ensure compliance with this contract. • When seeking medication, I agree to advise medical personnel of my situation and the need to take non-narcotic, non-addictive, and non-mood-altering medication. • I understand that if I fail to get permission from staff before consuming or filling prescriptions of any unapproved medication, I will be sanctioned by the court. • I understand that if I consume a product that contains my substance of choice that I will be sanctioned by the court under the guidelines of a relapse. • Listed below are the medications that I am currently taking that have been approved by the Drug Treatment Court staff:

Approved Medication Dosage Prescribing Physician

DRUG TESTING POLICY • I understand that it is my responsibility to submit my own valid specimens. • Staff has cautioned me about drinking excessive fluids prior to testing. • The program defines a dilute specimen per Cordant Laboratory standards. There are sanctions for providing a dilute sample. • Tampering with a drug screen can result in program termination. • I understand that I will be assessed a $30.00 fee for each lab confirmation when use is denied, which also includes THC level checks and dilutes. • I understand by signing below that I will be held to these standards while enrolled in the program.

Participant Signature Date

Drug Court Signature Date

VBC-0117 (9/9/20)

VBC-0147 (11/4/20) Page 22 of 30 Appendix E: Drug Treatment Court Unsuccessful Discharge Behavior Agreement

While you are in Drug Treatment Court your team is working to assure that you are making progress, one of the ways that progress moves forward is by having a positive attitude and working to create a relationship with program staff. The court has expectations of how you should behave in regard to treatment and in working with staff. The Drug Treatment Court Unsuccessful Discharge Behavior (form VBC-0225) ensures that you understand that certain behaviors could lead to you being discharged from the program. Below is a copy of the form:

DRUG TREATMENT COURT UNSUCCESSFUL DISCHARGE BEHAVIOR AGREEMENT

Court Address Court Telephone No. 212 E. Paw Paw Street, Paw Paw, MI 49079 (269) 657-8200

As a participant in the Drug Treatment Court, the following is a list of behaviors that the Judge has the discretion to automatically discharge you from the program unsuccessfully:

 Absconding, which is signified when a bench warrant is issued. Absconding for more than 60 days or absconding on two different occasions could result in an unsuccessful discharge.

 Possession or purchase of pseudoephedrine.

 Tampering, defined as the attempt or act of using a foreign specimen or device when testing.

 Submission of forged documents, second such offense could result in an unsuccessful discharge.

 Engaging in assaultive, threatening, or intimidating behaviors towards specialty court staff.

 In addition, the program judge has discretion to discharge participants for repeated non-compliance, new convictions, or egregious acts that threaten public safety or program integrity.

 Felony charges bound over to Circuit Court will be automatically terminated per MCL 600.1074.

Participant Printed Name

Participant Signature Date

Drug Treatment Court Signature Date

VBC-0225 (9/17/19)

VBC-0147 (11/4/20) Page 23 of 30 Appendix F: Drug Treatment Court Peer Support Specialist Behavior Agreement

While you are in Drug Treatment Court you are required to meet with a Peer Support Specialist. This member of the team is a valuable asset to you, as they have been on a journey that is similar to yours, they have gone through the program with success and will serve as a great resource in your recovery. The Drug Treatment Court Peer Support Specialist Behavior Agreement (form VBC-0305) is a list of the rules and expectations of your behavior while working with your Peer Support Specialist. Your signature states that you agree to follow these rules and work cooperatively with this member of your team. Below is a copy of the form:

DRUG TREATMENT COURT PEER SUPPORT SPECIALIST BEHAVIOR AGREEMENT

Court Address Court Telephone No. 212 E. Paw Paw Street – Suite LL001, Paw Paw, MI 49079 (269) 657-8200

As a participant in the Drug Treatment Court, you will be required to meet with a Peer Support Specialist (PSS). The following is a list of rules that you will be expected to follow:

 Leave all weapons, pocketknives, scissors, box cutters, razor knives, chemical sprays or other objects that would be potentially dangerous at home.

 You are responsible for contacting your PSS for required appointments. Try to schedule your next appointment at the conclusion of your meeting.

 There is NO smoking while in your PSS vehicle or during your appointment.

 There is NO cell phone use while in your PSS vehicle or during your appointment.

 Children are not permitted during one on one PSS appointments. You must have prior approval to bring children on any transport assistance. Your PSS is NOT responsible for childcare.

 Your PSS is only helping with transportation to and from program requirements. The PSS is NOT responsible for extra stops. Ex: grocery shopping, snacks before meetings, cigarettes, etc.

 Please be respectful of confidentiality. There is no need to discuss other’s program status, progress, etc.

 Recovery is KEY. Dwelling on the past in presence of others may be a trigger. Focus on the positives.

Participant Signature Date

Drug Treatment Court Signature Date

VBC-0305 (10/4/19)

VBC-0147 (11/4/20) Page 24 of 30 Appendix G: Drug Treatment Court Courtroom Behavior Agreement

As a participant in the Drug Treatment Court, you will attend drug court every other week. The Drug Treatment Court Courtroom Behavior Agreement (form VBC-0115) outlines the rules that you are expected to follow. By following these rules, it will show the court staff that you respect the court and those that are partnering in your recovery journey. Below is a copy of the form:

DRUG TREATMENT COURT COURTROOM BEHAVIOR AGREEMENT

Court Address Court Telephone No. 212 E. Paw Paw Street – Suite LL001, Paw Paw, MI 49079 (269) 657-8200

As a participant in the Drug Treatment Court, you will attend drug court every other week. The following is a list of courtroom rules that you will be expected to follow:

 Leave all weapons, pocketknives, scissors, box cutters, razor knives, chemical sprays or other objects that would be potentially dangerous at home.

 Eat before you come to court. NO food, beverages, candy or chewing gum will be allowed.

 Wear appropriate clothing for court. Inappropriate attire such as T-shirts, undershirts, muscle shirts, halter tops, miniskirts, ball caps or hats (unless worn for religious proposes) should not be worn. Also clothing with advertisements, pictures or language pertaining to alcohol, drugs, sexual or illegal behaviors will not be permitted.

 Use appropriate language. The judge will want to hear your input, but it must be delivered with respect.

 No cellular phones or pagers will be allowed.

 Pay attention to the court proceedings and please keep your comments related to the court session. Please do not sleep or act disruptively during the court sessions.

 Stay in the courtroom until you are excused. Bathroom breaks and public telephone calls are not permitted.

 Make sure you have childcare when you are scheduled for court sessions. If this is not possible, please speak with your case manager no later than 12:00 P.M. (noon) the Thursday before court.

Participant’s Signature Date

Participant’s printed name

Drug Treatment Court Date

VBC-0115 (8/9/19)

VBC-0147 (11/4/20) Page 25 of 30 Appendix H: Specialty Court Notice of Prohibition Against Redisclosure

The Specialty Court Notice of Prohibition Against Redisclosure (form VBC-0309) is a confidentiality agreement between you and the team. The team will not share your private information with anyone that is not agreed upon by you in the release of information that you signed. You are agreeing to not disclose private information to others regarding other participants and this is a legal form to ensure that all members do not release information unless you have given permission. Below is a copy of the form:

SPECIALTY COURT NOTICE OF PROHIBITION AGAINST REDISCLOSURE

Court Address Court Telephone No. 212 E. Paw Paw Street – Suite LL001, Paw Paw, MI 49079 (269) 657-8200

Disclosure of any participant’s confidential information that is made by a team member may only be made if there is a signed consent to release information form on file and it must be accompanied by one of the following written statements:

(1) This information has been disclosed to you from records protected by federal confidentiality rules (42 CFR, Part 2). The federal rules prohibit you from making any further disclosure of information in this record that identifies a patient as having or having had a substance use disorder either directly, by reference to publicly available information, or through verification of such identification by another person unless further disclosure is expressly permitted by the written consent of the individual whose information is being disclosed or as otherwise permitted by 42 CFR, Part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose (see § 2.31). The federal rules restrict any use of the information to investigate or prosecute with regard to a crime any patient with a substance use disorder, except as provided at §§ 2.12(c)(5) and 2.65; or

(2) 42 CFR, Part 2 prohibits unauthorized disclosure of these records.

Participant’s Signature Date

Case Manager Signature Date

VBC-0309 (3/5/20)

VBC-0147 (11/4/20) Page 26 of 30 Appendix I: Drug Treatment Court Prohibition of Ingredients Used to Manufacture Methamphetamine

The Drug Treatment Court Prohibition of Ingredients Used to Manufacture Methamphetamine (form VBC-0121) goes along with the medication and drug policy agreement. Here you are agreeing that you will not possess nor purchase anything that is used in the creation of meth or that contains pseudoephedrine. You are also signing that you are aware that if found to have purchased any of these items you could receive a sanction, jail time, or be discharged from the program. Lastly, you are agreeing that you understand that program staff can conduct a search and that they can remove them from your possession. Below is a copy of the form:

DRUG TREATMENT COURT PROHIBITION OF INGREDIENTS USED TO MANUFACTURE METHAMPHETAMINE

Court Address Court Telephone No. 212 E. Paw Paw Street – Suite LL001, Paw Paw, MI 49079 (269) 657-8200

I, , DOB, / / SSN, - - I acknowledge that my participation in the Drug Treatment Court is a condition of my probation, parole, bond, or the disposition of criminal proceedings against me. As a result of such, I must comply with the following terms and requirements of the Drug Treatment Court program:

I understand that I may not possess the following items used in the production of methamphetamine, specifically: Acetone Alcohol (isopropyl or rubbing), Anhydrous ammonia and ammonium sulfate (fertilizer), Battery acid (sulfuric acid), Bleach, Coleman fuel, Drain cleaner (sulfuric acid or caustic soda), Drain openers such as Red Devil lye Heet and Iso-Heet, Gasoline additives (methanol/alcohol), Hydrogen peroxide, Iodine (both crystal and liquid), Lithium batteries, Matches (red phosphorous), Mineral Spirits, Muriatic acid, Over the counter cold pills containing ephedrine or pseudoephedrine, Salt (table or rock), Sodium and Lithium metal Starting Fluid (organic ether), Toluene Trichloroethane (gun cleaning solvent)

I understand that I may not possess or purchase pseudoephedrine for ANY reason. If I violate this agreement, I understand that I will be subject to a sanction that may include incarceration and unsuccessful discharge from the program.

I understand that case managers or police officers may search my residence, car, or dwelling where I am found and can remove suspicious items, such as large quantities or a combination of items from the prohibited list above.

Participant’s Signature Date

Treatment Court Signature Date

VBC-0121 (11/17/17)

VBC-0147 (11/4/20) Page 27 of 30 Appendix J: Drug Treatment Court Non-Discrimination Statement

The Drug Treatment Court Non-Discrimination Statement (form VBC-0122) is for your protection and to state that the court does not discriminate on basis of race, color, religion, creed, gender, age, national origin, ancestry, disability, sexual orientation, or marital status. Both your team and you will sign to ensure that your rights are protected. Below is a copy of the form:

DRUG TREATMENT COURT NON-DISCRIMINATION STATEMENT

Court Address Court Telephone No. 212 E. Paw Paw Street – Suite LL001, Paw Paw, MI 49079 (269) 657-8200

The Van Buren County Circuit Court and Treatment Court programs do not discriminate on the basis of race, color, religion, creed, gender, age, national origin, ancestry, disability, sexual orientation, or marital status.

If your federally protected rights are violated, you may file a complaint with the Office of Civil Rights at • (202) 514-4609 or • (202) 514-0716 (Telephone Device for the Deaf)

Participant’s Signature Date

Treatment Court Signature Date

VBC-0122 (11/17/17)

VBC-0147 (11/4/20) Page 28 of 30 Appendix K: Drug Treatment Court Medical Emergency Agreement

The Drug Treatment Court Medical Emergency Agreement (form VBC-0118) is so that if a medical emergency should occur and you are not able to complete any or some of the tasks that you are responsible for, you agree to contact your team on the way to the hospital. If you must leave a voicemail it must be detailed with the date, time, and type of emergency. This will ensure that you are covered in regard to following the guidelines of the program. You must provide documentation that you were seen, and you are responsible for canceling appointments. Also, you are signing that you agree to be tested if deemed necessary and that you may be asked to sign a release of information for the place of care. Below is a copy of the form:

DRUG TREATMENT COURT MEDICAL EMERGENCY AGREEMENT

Court Address Court Telephone No. 212 E. Paw Paw Street – Suite LL001, Paw Paw, MI 49079 (269) 657-8200

I, , DOB, / / SSN, - -

I acknowledge that my participation in the Drug Treatment Court is a condition of my probation, parole, bond, or the disposition of criminal proceedings against me. As a result of such, I must comply with the terms and requirements of the Drug Treatment Court program.

Should I have a medical emergency that affects my ability to meet program requirements, I must do the following: 1) Contact my case manager on the way to the hospital and when leaving the hospital. If I am unable to reach them directly, I understand that I must advise of the date, time, and the emergency event on voicemail. 2) Obtain documentation from the hospital of my admission and discharge time and date. 3) Contact any parties that I have scheduled or expected appointments with and inform them of the emergency. This includes court appearances, therapy appointments, and drug testing. If you are expected at drug testing, you may not just leave a message. You must speak directly with a tester regarding your emergency.

I understand that medical emergencies do not negate my responsibility to meet DTC requirements and that my case manager or drug testers may direct me to do the following: 1) Sign a release between DTC and the treating hospital. 2) Obtain substance abuse testing at the hospital, which will be paid at my own expense.

I understand that it is my responsibility to be aware of this policy and to comply with the outlined expectations. Should I fail to abide by this policy, the court will issue an appropriate sanction for my behavior.

Participant’s Signature Date

Treatment Court Signature Date

VBC-0188 (11/17/17)

VBC-0147 (11/4/20) Page 29 of 30 Congratulations! We are here for you in times of struggle and in moments of success, all you have to do is reach out, be honest, and make forward progress!

VBC-0147 (11/4/20) Page 30 of 30