Best Practices for Recovery Houses Fred Way Pennsylvania Alliance - - PowerPoint PPT Presentation

Best Practices for Recovery Houses

Fred Way

Pennsylvania Alliance of Recovery Residences National Alliance for Recovery Residences s

• In Fisc

scal al Year 1995 the Philad adelphia lphia Coordinating inating Of Office ce for Drug and Alcohol l Abu Abuse Progra rams ms (COD ODAAP AP), ), now known wn as The Of Office ce of Addict ictio ion n Services ices (OAS) ) initiat itiated d a recovery house system m for persons s enrolled d in state license sed d

• ut patien

ient substance ance abuse progra rams. ms.

• The goal of the initiativ

itiative is to improve treatment ment outcomes s by stabiliz ilizing ing the living ing envir ironment

• nment of persons

s in recovery who wou would d oth

• therwi

wise se reside de in housing ing situat uatio ions ns that are re not

• t

conduciv ucive to their recovery. .

HISTORY OF OAS RECOVERY HOUSE SYSTEM AND STANDARDS

• Recover

ery house se stand andar ards ds

• utline

line the minim imum um level l of physica ical l plant nt and nd programm grammati atic activit ivity y that t will ll govern ern Departm tment nt of Behavioral vioral Health lth/ / Intellect ellectual ual Disability ability Services ices (DBH DBH IDS) DS) Office e of Addiction ction Servic ices es Recover ery y Houses ses and their ir relati ationships

• nships with

h licensed nsed treatm eatmen ent t provider viders, s,

• ther

er social al servic ices es programs grams and nd the immed mediat iate e commun munit ity. .

HISTORY OF OAS RECOVERY HOUSE SYSTEM AND STANDARDS

His istory y of OAS Rec ecover ery y House se System em and d Standa dards ds

• These

se stand andar ards ds were developed eloped in 1995 by Coor

• rdi

dina nati ting ng Office ice of D&A Abuse use Progra rams ms (COD ODAAP), P), now know as DBH H IDS Office ice of Addict ction

• n

Services, ices, with direct t inp nput t from over a dozen en Philade adelphi phia a recovery y

• rgani

nizat ation/hou

• n/houses

ses commi mmitt tted ed to imp mprovin ing g the care of people strivin ing g to maint ntain in a health thy y and producti ctive e life style. e.

THE HE HI HISTOR ORY Y AND ND EFF FFORT RTS S OF T F THE HE NA NATIONA ONAL ALL LLIAN ANCE E FOR RECOVER VERY Y RESIDENC DENCES ES (N (NARR) R)

In the general l communi nity ty, and even among treatm tmen ent t provi vide ders, , recover ery y resi side dence nces s are

• ften

n misund sunder erst stood d and reviewed d suspicious spiciously, , despi pite growing ng evide denc nces es of the effecti ctivenes eness of them. . Indeed, ed, unti til relati tively y recently ntly, , there re wa was neith ther r clear conse sensu nsus s

• n what consti

stitut uted d a r recover ery y resi sidenc dence nor mini nimum um standar ndards ds for the qu quality of them, m, much less s suppo pport t for the thousa usand nds s of recover ery resi side dences nces currently rently operatin ating across ss the nati tion.

• n. Founde

ded d in 2011, the Nationa nal Allianc nce for Recovery y Resi side dence nces s (NARR) was was created d to provide vide a f forum um for exchanging nging ideas, as, problem m solvi ving ng and advocacy, , and developin

• ping uniformi
• rmity

ty among recover ery resi side dences nces across ss the nation.

• n. From

m this effort t grew a w work rking ng defini niti tion n of recover ery y resi sidenc dences, es, a t typol

• log
• gy

y disting stingui uishing hing different rent types, es, and standar ndards ds for them.. ..

THE HE HI HISTOR ORY Y AND ND EFF FFORT RTS S OF T F THE HE NA NATIONA ONAL ALL LLIAN ANCE E FOR RECOVER VERY Y RESIDENC DENCES ES (N (NARR) R)

Today, , even thoug ugh h they y are referred erred to by a var variet ety y of different erent names, s, such ch as Oxford d Houses, es, sober living house ses, s, and recovery y homes, s, it is under erst stood d that t recovery y resi side dences nces are sober, , safe and healthy y livi ving environme nment nts s that t prom

• mote recover

ery from m alcohol and drug ug abuse and associ ciated ed prob

• blems

ems At a m mini nimum, mum, recover ery resi side dences nces offer er peer-to to-pe peer r recovery y suppo pport t with th some providi viding ng prof

• fess

ssiona nally-de delivere ered d clini nical servi vices es aimed d at promoti ting ng absti tine nence nce-base ased, d, long term m recovery. . In 2013 13 NARR merged d with th the America can n Halfway House se Alcoholism sm Progra rams ms (AHHAP) to promote e the joint nt miss ssion n of suppo pporting ng perso sons ns in recover ery from m addicti ction n by i impr mproving ving their access ss to qu quality ty recovery y resi side dence nces s through ugh standar ndards ds, , suppo pport t servi vice ces, s, placement nt, education, ation, resear arch h and advocacy.. ...

THE HE HI HISTOR ORY Y AND ND EFF FFORT RTS S OF T F THE HE NA NATIONA ONAL ALL LLIAN ANCE E FOR RECOVER VERY Y RESIDENC DENCES ES (N (NARR) R)

As As a 50 501-c3 no nonpr prof

• fit and

nd rec ecover ery community unity or

• rganiz

nizati tion

• n (RCO

CO), ), NARR ARR curre currently ntly ser erves es reg egion

• nal

al af affiliat ate org rgan aniza zati tion

• n in

in 19 19 stat states es by by host

• sting

ng a websit site an and monthly

• nthly conf

confer erenc ence call with with af affiliat ates es to to pr provi vide de sup suppor

• rt an

and technic echnical ass assistanc stance, e, dis distri tribut uting ng a month

• nthly

ne newsl wslett tter er to to kee eep af affiliat ates es inf nform

• rmed

ed of

• f eme

mergi ging ng issues sues acr acros

• ss the

the countr country, an and providi viding ng periodi

• dic webina

nars to to affiliat ates es and key stakeho holder ders Th These ese affiliate organiz

• rganization
• ns coll
• llecti

ctively ely suppo support over er 25 25,000 00 pe persons sons in in rec recover ery fr from

• m a

substanc substance use use disor disorder der who who are are living ng in in 2,500 500 ce certifi fied ed rec recover ery resid residenc ences es th throug

• ughout
• ut

the the Uni nited ed Stat States

• es. This

his present presentat ation pr provi vides des an an overvi view of

• f the

the hist histor

• ry an

and mis mission

• n of
• f

NARR an and wor

• rk co

compl pleted ed to to dat date deli eline neat ating ng levels els of

• f care

are for

• r di

differe erent nt type types of

• f re

reco cover ery res esidenc dences es (e (e.g., peer er-run, run, monit

• nitored

red, super supervised, vised, an and ful fully staf staffed) ed) an and de devel elopi

• ping

ng standa ndards ds for them.

NATIONAL ALLIANCE OF RECOVERY RESIDENCES

In In May 2013, the he Nati ational nal Alli Allian ance ce for

• r Rec

ecovery Reside esidences nces (N (NARR) ARR), for

• rmerl

merly the the Nat atio iona nal Assoc Associa iatio tion of

• f Reco

ecovery Reside esidences, nces, modif modifie ied it its na name me to to mor more cl close

• sely reflect

eflect it its 50 501c3 no nonprof

• fit

it mi miss ssio

• ion. Moreo

Moreover er, the the na name me cha change nge ma marks ks a hist istori

• ric even

ent, t, the the me merge ger of

• f NARR

ARR and and the the Assoc Associa iatio tion of

• f Hal

alfw fway House

• use

Alcoh cohol

• lic

ic Pr Prog

• gram
• ams. Incor

ncorpo porat ated ed in in Min innesot nesota in in 196 966, AHHAP AP is is the the ol

• ldest

dest reco ecovery residence esidence organization ganization in in the the US, US, and and as as a resul esult of

• f the

the consolid consolidat ation ion, NARR ARR has has mo moved ed it its of

• ffices

ices to to 649 49 Grand and Ave#4, St

• St. Pau

aul, Minneso innesota ta 55105. AHHAP’s lea eade dershi ship hel helped ped found und NARR ARR, and and their their wisd wisdom

• m aroun
• und str

structure ucture an and lan anguage guage continue continues to to pl play a huge huge rol

• le in

in NARR’s rap apid succes success. The he me merge ger is is a pa pass ssin ing of

• f the

the torch, ch, and and NARR ARR is is hono honored to to ca carry the the AHHAP AP leg egacy acy for

• rwar

ard as as ou

• ur na

nati tion

• n un

undergoes goes hea healthca thcare ref efor

• rm and

and mo moves es towar ards ds a re recover ery-orie

• rient

nted ed system em of

• f care

re.

PARR is an OAS provi vider der in the communi nity ty Respo pons nsible e for visiti siting ng and eva valua uati ting ng local recover ery houses ses in Philade delphia phia and surr rroundin unding areas Offer ers techni hnical l assi sist stanc nce e and guidanc dance with th certific fication ation and standar ndardiz dizati tion n process ess Certi tifies fies PARR eligible sites es when they y meet et necess ssar ary standa ndards ds

RELATIONSHIP BETWEEN PARR AND OAS

• A sa

A safe e place e where here some meone ne in reco cover ery y can live

• A p

A place e where ere reside idents nts live togeth ther er as a communi mmunity ty

• A h

A home me or an apartme tment nt for which ch expens penses es may be sh shared red by ot

• ther

her reco cover ering ing housem semates; es; reside idents nts pay their eir own n rent t and cover er thei eir r

• wn

wn expenses penses, except ept in those

• se

cases es where here financi ancial al assista tanc nce e is available ble

RECOVERY HOUSING AND CONTINUUM OF CARE: A RECOVERY HOUSE IS….

• For
• r

ind ndividua uals ls with th substa substance nce use use diso sorder ers and and gener general ally ly co consi nsists ts

• f
• f

alcoh alcohol- and and dru rug-fr free ee re residence ences, s, su such ch as as sober er living ving houses uses.

• Of

Often en pr provi vided ed to to ind ndividual uals after er the they ha have been been in in an an inpat patient ent or

• r resi

esident ential treat treatme ment nt pr prog

• gra

ram or

• r dur

during ng th their fi first rst few mont months hs of

• f re

reco cover ery or

• r sobr

sobriety

• ty. Rec

ecover ery ho housi using ng is is no not form

• rmal

al treat treatme ment nt; rath rather er, it it is is a se service ce th that at supp suppor

• rts re

reco cover ery duri uring ng

• r
• r af

after er trea treatm tment

• nt. Th

Thus us th there ere is is gu guidance ance about about what what con constitut stitutes re reco cover ery ho housi using ng, but there re are no no clear ear standar ndards ds.

• Of

Often en used used by by individual uals who who do do no not or

• r no

no lo longer nger re requi uire re higher higher le levels ls of

• f care,

are, su such ch as as ho hosp spita tali lizat zation or

• r lo

long ng-ter erm resi esident ential treat atme ment nt.

RECOVERY HOUSING AND THE CONTINUUM OF CARE: A RECOVERY HOUSE IS…

RECOVERY HOUSING AND THE CONTINUUM OF CARE: A RECOVERY HOUSE IS…

• Of

Often en a st step ep on

• n th

the way to to independent independent li living

• ing. It

It sh shoul

• uld be

be noted ed th that th there ere is is co concern ncern tha hat individu individuals ls who ho uti utili lize ze abs absti tinence ence-con conti ting ngent nt housing housing ma may be be at at ris risk for

• r hou

housi sing ng inst instabi abili lity ty if if rela relaps pse occ

• ccurs du

during ring the process cess of

• f reco

cover ery.

• A ty

type pe of

• f ser

ervice vice us used ed for

• r in

indiv dividu iduals ls wit with subst bstance ance use use dis disor

• rder

ders who ho are re st steppi epping ng do down wn fr from

• m in

inpatient atient or

• r res

residential idential care care or

• r wh

who are are not ready ready or

• r able

able to to liv ive ind indepe epende ndently

• ntly. This

This li literatur erature re revie view examined xamined the he avai aila lable le res research ch on

• n reco

recover ery hou housi sing ng to to de determine ermine it its relat relativ ive value as as a treatm tmen ent approa

• ach

ch.

RECOVERY HOUSING AND THE CONTINUUM OF CARE: A RECOVERY HOUSE IS NOT…

• Formal

al treatme tment nt; rather, it is a service ce that t suppor ports ts recover ery during g or after treatme tment nt

• A level

el of care withi hin n the Pennsylv sylvan ania ia Clien ent t Placemen ement t Criteri eria a (PCPC) PC) & does not

• t provide

de det etox, x, inpati npatient nt, or r outpati tien ent t drug and alcohol hol counseling nseling

• Usual

ally y funded ded through gh medical cal insuran ance ce or treatme tment nt dollar ars

• Licensed

nsed by the State

DESCRIPTION OF RECOVERY HOUSING

Service ce Defini niti tion: Recovery housing sing is is a direc rect servi vice with th multi tiple compone nent nts that provi vides des individ dividua uals ls with th mental and subst stance nce use disor sorder der with th super ervised vised short-term rm hous

• using

ng. Ser ervic vices es may include ude case manageme ment, nt, ther therape apeuti utic recr ecrea eati tion

• nal

al activiti activities, es, an and pe peer er coaching aching or

• r

suppo pport. Service ce Goals: Incre rease se the individual’s stability; impr mprove the person’s functi nctionin

• ning; help the indi

dividua vidual move towar ward a life that is is int ntegrat rated ed int nto the communi nity ty Populations ations Indi divi viduals duals with th subst stanc nce use disor sorder ders or

• r those

se with th co co-occurrin urring menta tal and substa stance nce use diso sorder ders Set etti tings of

• f Servi

vice delivery Set etti tings may va vary and incl clud ude sober livi ving ng house ses.

NARR Provides: Comprehensive nomenclature National standards to promote quality Certification program 19 state affiliate

• rganizations

NARR NARR NARR NARR NARR

NARR Recovery Residences: 4 Levels of Support

Peer Elected Peer Monitor Staff Supervised Residential Treatment

Why Recovery Housing? Why Now?

⟫ Moving from acute care to chronic disease model ⟫ Health reform, Medicaid expansion ⟫ Payment reform, integrated care ⟫ Increasing attention to opiate crisis Despite challenging social and economic trends, several factors offer

• pportunities to

support and expand recovery housing.

OAS RECOVER VERY HOUSE E STANDAR ARDS: S: MISSI SION ON & & PHILOSOPHY OSOPHY

Recovery house standards are a collaborative effort that provides the framework and overall goals that recovery organizations agree to adhere to in an effort to promote a safe, drug free and stable living environment that is conducive to recovery.

Each h reco cover ery y house se must st secure cure appropr

• priat

ate e zoning ng for r the number ber of peopl ple e resi siding ng in the house se (Cer erti tificat ficate e of Occupanc cupancy) ) Each h reco cover ery y house se will ll adhere ere to all l fire re codes es and maintai ntain n requi uired red equipm quipment ent incl clud uding ng smok

• ke

e det etect ector

• rs,

and acces cessib sible le fire re exti tinguisher

• nguishers. Fire

re drills ls and emerg ergency ency evacuati vacuation

• n

proced cedures ures will ll be conduct ucted ed regul ularl arly

PHYSICAL ICAL PLANT CODES S

Each recover ery house use will l adhere re to all applic licab able le health lth codes Each recover ery house se will l adhere re to all applic licab able le housing sing and nd License nse and nd Inspec pecti tions

• ns codes

s

PHYSICAL SICAL PLANT ANT COD ODES ES

The recove

• very

ry house se wil ill l contai tain n adequa quate te furnitur ture e per perso son, n, a kit itch chen en facility, ility, bathr hroom

• om and li

livin ing g space ace per residen ident t and suffi fici cient ent common n space ce for the number r of people ple residi iding ng in in the house se

PHYSICAL SICAL PLANT ANT COD ODES ES

• The

e minim imum m space e per occu cupan ant t per sleepin eping room

• ms

s must t be 70 square re feet t for a o

• ne-person

person room,

• m, or if occupied

upied by more re than one e person, son, 50 square e feet t in an area for each ch person son

• There

ere must t be adequa uate e light, t, venti tilat ation ion, , heat, t, and safe e and sanit itary y maintena enance ce

• For

r each ch six persons sons or less, s, a standa dard d bathr hroom

• m (incl

cluding uding a wash h basin, in, toilet, t, and shower r or tub) ) must t be accessi essible le from

• m a comm

mmon

• n hall and must not
• t be

more re than one e story y remo moved ed from

• m the

e room

• ming

ing unit t of the e inten ended ed users

PHYSICAL SICAL PLANT ANT / C / COD ODES ES

It is a requi uire reme ment nt to

• bta

tain in compreh rehensi ensive e gener eneral l liab abili ility ty insur surance ance that at provi vide des s coverag erage e for r inju jury y to resid sidents nts, , visit itor

• rs,

s, or prope

• perty

ty dama amage ge

COMPRE PREHENS HENSIVE IVE GENERAL ERAL LIABILIT ITY Y INSURANC RANCE E

Sta taffin ing g Cover erage age

Sup uper ervi visi sion

• n

Ea Each reco cover ery y house use will have e on site e a desi signa gnated ed indivi ividual dual respon ponsib sible le for house se opera erati tion

• ns

s 24/7. Medi dica cati tion

• n

Manageme agement nt procedures dures will be developed eloped to contr trol any prescr crip iptio tion n medica icatio tions ns within in the house.

• se. Proce

cedures dures will include ude a locked ed cabine net, t, medica icatio tion n logs s and process ess for obser serving ing the takin ing g of medica icatio tion.

• n. The

e house e will also have e a clear ar written en policy cy on non-pres prescr crip iptio tion n or

• ver-the

the-cou

• unt

nter er pharma maceu ceuti tical cals. s.

TRAINING FOR STAFF

Al All staff f mus ust t recei ceive e recover ery organi anizati zation

• n/h

/hou

• use

se safety ty rul ules es and any y emergenc mergency y procedures cedures. . Program ram staff f will com

• mple

lete e the e DBH/IDS IDS Addicti ction

• n Services

vices sponso nsored red Reco cover ery y House use Trainin ning g Series ies or equi uival alent ent Penn nnsy sylvani ania a Certif tifica icati tion

• n Board

d (PCB) ) approved d se serie ries. .

DESCRIPTION OF INTAKE CRITERIA AND PROCESS

Each h re recover ery org rganizat izatio ion/ n/hou

• use

se will have a clear r written n descr cripti ption

• n of the intak

ake criteria ia or house e target t populati ulation

• n and the specif

cific ic steps ps invol

• lved

ed in the intak ake e process ess.

CLEARLY ARTICULATED AND DOCUMENTED HOUSE RULES

A verbal orientation will be provided for all new residents covering house rules/regulations The visiting hours and house visitation policy will be documented Curfew limits will be documented A schedule on the collection of resident fees will be distributed upon admission (this document should be signed by resident) Expectations on attending fellowship meeting and house meeting will be included in the written rules

Clearly Articulated and Documented House Rules

A clear policy on random urine testing for residents Pre-set sanctions for use and a clear prohibition of substance abuse in the house will be part of the written house rules (and on contract) The recovery house will establish a standard grievance process for those facing disciplinary action, loss of privileges, or early termination Each recovery house will develop policies promoting appropriate house/community behavior and discouraging violence/fighting Each resident will sign a document attesting to the fact that the house rules were explained and that they will fully make a commitment to abide by the documented house rules

Each house se will mainta ntain n or have access s to indivi dividual dual files es containin aining g basic informatio

• rmation

n on each resident. dent. Indi divi vidua dual files les will include, lude, at the mini nimum, um, contact ct with h out pati tient nt counsel selor

• rs, the signe

ned d house se rules, es, occupa panc ncy y agreement nt and payment nt log, any necess ssary y signed ned resi side dent nt release se forms, ms, comp mpleted d inta take/admi e/admissio sion n form, m, results ults of urine ne drug g scre reens ns, not

• tes

es related d to any house se sancti ctions

• ns and grievance

nce process ess if ini niti tiat ated d Files es will also contain ain a br brief ef disc scharg harge summar mary y or form m with th their eir length th of stay, , disc scharg harge date, , statu atus at disch scharg rge, e, (clean and sober or using) and disposi sposition

• n or desti

tina nati tion n upon n disc scharg harge Other documents will be included in the residents’ records as requ quire red d by the referral erral or fundin ding source ce All resi sident dent files es will be k kept t in a l locked d file cabinet net

RESIDENTIAL RECORDS

RELATIONSHIPS WITH LICENSED TREATMENT PROVIDERS

Recovery organizations/ houses will have relationships with programs providing formal treatment in the following areas:

• Licensed D&A Treatment Programs/ Co-occurrence

Treatment Programs

Any letters of agreement will identify responsibilities for treatment, support service and ongoing coordination/communication between the recovery house and provider

Rel elationsh ationships ps wi with th Licensed censed Trea eatme tment nt Pr Provider viders

Where there are existing connections between residents and treatment providers, recovery house will promote & support those linkages Each recovery house will have clearly defined procedures for accessing these services (substance abuse, mental health) when an emergency situation arises

AWARENESS AND ADHERENCE TO FEDERAL AND STATE REGULATIONS ON CONFIDENTIALITY AND NON- DISCRIMINATION

Awareness and Adherence to Federal and State Regulations on Confidentiality and Non- Discrimination

Reco cover ery y house se staffs fs are requi uired red to follo low w federa ederal l and state e regula ulati tions

• ns strictl

ctly y limiti ting ng disclos losure re of conf nfiden idential tial information

• rmation on

each h residen ident.

• t. (No

Note: e: Know w HIPPA A regul ulat ations) ions) Reco cover ery y house e st staff f will adher here e to fede deral al st statut utes prohi hibi biti ting ng discr crim iminati nation

• n or bias against

st reside sidents. nts. Non

• n-Exp

xploit loitati tion

• n of Residen

idents- Reco cover ery y organ aniza izati tion

• ns/h

s/houses

• uses will

not

• t permi

mit t any type e of residen ident t exploi loita tati tion

• n includin

uding g sexu xual al abuse, use, physi sica cal intimi imidat dation, ion, financ ancial ial mani nipulat ation ion or forced ced labor

• r for

anyone’s profit.

National ional Allian ance ce for Recover ery Resid iden ences ces NARR RRonlin

• nline.or

e.org Fred Way Email- fredway@y y@yma mail il.com com 267 267-388 88-854 546 Pennsylv sylvan ania ia Alliance nce of Recover ery Reside idence nces Fred Way Email – fredway@ymail y@ymail.com com 267 267-388 88-854 546

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