Pres esen ent er fletchergroup.org TOPIC S S TO DIS S C C - - PowerPoint PPT Presentation

Pres esen ent er

DAVE JOHN SON , M SW,

ACSW

Project Administrator

fletchergroup.org

TOPIC S S TO DIS C S C US S S S RC RC ORP RP-RC OE C C

• re Activ

ivit itie ies

1) Overview of RCOE 2) Recovery Housing and Recovery Ecosystem 3) Recovery Housing Outcomes 4) Funding Models 5) Providing technical assistance

T H E F L E T C H E R G R O U P F O R R E C O V E R Y H O U S IN G

Our H Hist st or y

KENTUCKY ORIGINS

Our recovery expertise began in 2004 when Governor Ernie Fletcher launched Recovery Kentucky—18 recovery residences that have helped thousands of people rebuild their lives while saving millions in taxpayer dollars.

Our C

• C
• -in

investig igator

Di Director Terry B Bunn, unn, PhD hD

KIPRC works to reduce injury through education, policy initiatives, public health programming, surveillance, risk factor analysis, direct interventions, and evaluation.

PARTNER ERS

ON ONE V VOI OI CE

We work hand-in-hand with NARR and

• ther partners to ensure a nationally

unified voice for Recovery Residences supporting people in recovery.

Dedicated to expanding access to quality Evidence-Based Recovery Housing for all populations, particularly the most vulnerable.

To reduce morbidity, mortality, and

• ther adverse outcom es associated

with Substance Use Disorders, particularly Opioid Use Disorders in rural c l com m unit it ie ies where guidance is needed to address not

• nly the current opioid crisis, but

future crises as well.

HRSA SA Man andat at e

N ATION AL/ TARGETED REACH

We're working in rural com m unities in Montana, Idaho, Washington, Oregon, Kentucky, Georgia, West Virginia, Ohio, and other rural com m unities as requested

RECO VERY HO USIN G

With an em phasis on the hom eless and those with SUDs involved with crim inal justice.

EVIDEN CE-BASED TA

Field-proven tools and expertise to m axim ize com m unity effectiveness

Our ur F Focus us

Our ur C Cul ult ur ure

TEAM -ORIEN TED

We excel at developing partnerships with stakeholders of every kind— federal, state and private sector.

COM M UN ITY EM PHASIS

No project can succeed without local understanding, buy-in, and support.

FLEXIBLE

We are uniquely agile and purpose- driven.

Colla llaborat io ion

Int egrat in ing S Silo ilos

PARTN ERIN G

SAMHSA’s BSS-TACS NIH HEALing Communities State NARR Affiliates HHS’s Findtreatment.gov

IN TEGRATIN G WITH STAKEHOLDERS

Integrate with community efforts not rebuild

N ON -COM PETITIVE

Who gets the credit?

Th The Ch Challenges

CON FUSION

Desperate families spend thousands

• f dollars with little to show.

LACK OF RESOURCES

Rural communities, in particular, lack the funds and resources to respond.

CHAOS

Recovery Housing is an unregulated industry prone to fraud and abuse.

RECOVERY RESIDENCES IN THE CONTINUUM OF RECOVERY

NARR RR Levels s Of Of Suppo ppor t

RECOVERY RESIDENCES IN THE CONTINUUM OF RECOVERY

Fo Four Dis ist in inct Le Levels

• In 2018 over 68,000 overdose

deaths were reported, with 60% resulting from opioid

• verdoses.
• Many occurred soon after

release from prison.

• A holistic approach takes a

community view to address individuals impacted by substance use disorders.

Est abli lishin ing A R Rec ecover er y Ec Ecosyst em

THE N E N EED EED F FOR A A HOLISTIC A C APPROACH CH

Rec ecover er y E Ecosyst em em s

• Criminal Justice
• Treatment

Providers

• Counselors
• Community

Support Groups

• Self-directed

Referral Sources:

Employment Support Case Management Peer Support Life Skills Development Education Support Health--physical and mental Stable Housing

Employment Transportation Housing Social Support

BUILDING RECOVERY CAPITAL

Challen enges es Uni nique ue To Rura ural Areas s

HI HI GHE HER C COSTS

Long-distance travel to facilities adds significantly to already high costs.

HI GHER RA R RATES

• f SUD incidence, morbidity,
• verdose occurrence and

mortality.

FEWER RE RESOURC RCES

Doctors diagnosing SUDs are less likely to have the resources and training for follow-up care.

GRE REATER R ST STI GM A

Smaller rural communities may experience less privacy and, as a result, more social stigma.

Un Unique e Cul ult ura ural Challen enges es

GEOGRAPHY

Widely dispersed facilities and the technicalities of insurance can present additional problems.

COM PLEXI TY

Areas lacking social services and education are also more likely to interact with the criminal justice system.

VULN LN ERABLE LE

More Native Americans meet the diagnostic criteria for SUD than any other ethnic or minority group.

DI STRUST ST

Of mainstream institutions exacerbated by treatment protocols that may be culturally insensitive.

Local co m m u n it y e ffo r t s In t e gr a t e w it h e xis t in g e ffo r t s St a t e e ffo r t s a n d s t r a t e gy Br in g d o w n s ilo s a n d in fo r m RH s t r a t e gie s

“All politics are local.”

Tip O’Neill, Speaker, House of US Representatives, 1977-1987

Top Down Ve Versus Bot

• t t om
• m U

Up

HRS RSA TARG RGETS

IN TERVEN TION

• Prevention programs
• Early intervention,

especially SBIRT

SURVEILLAN CE

• SUD/OUD screening

and diagnosis

• Fatal and nonfatal
• verdoses
• Service availability,

including MAT

HOUSIN G

• Recovery Housing

NARR Levels 1-4

• National Recovery

Housing Directory

• Training Portal
• Outcomes Portal

KI PRC RC

Developing a portal and mobile app to collect data from RH and patients.

DATA TA

Out co com es

Core Activity: 1) Science-based interventions

KI PRC C & N ARR RR

Developing an educational portal for access to educational models in best practices in RH

Ed Educat ion Train inin ing

Core Activities: 2) Dissemination of best practices in rural communities 3) Providing scientific and technical assistance

KI PRC RC N ARR RR SA SAFE P Pr o j ect

Integrate state and national data to create a national registry of RH for consumer access to quality and value.

RH RH D Direct or y

Core Activities: 2) Dissemination of best practices in rural communities 3) Providing scientific and technical assistance

FindTreatment.gov

FLETCHER ER GRO ROUP TECHN I CAL ASSI SSI STAN CE

Our goal is to provide all the expertise needed to establish Recovery Housing that's effective, proven, and sustainable.

TA TA

“Sou

• up To
• Nut s"

Core Activities: 2) Dissemination of best practices in rural communities 3) Providing scientific and technical assistance

S T S T A T E

• B

Y B Y

• S

T S T A T E

OPPO PPORTUN I TI ES

“Boot

• ot s
• n
• n

t he e Gro round und”

Help in g “Face t o Face” Becom in g p ar t

• f t h e

com m u n it y Un d er st an d in g t h e cu lt u r al n u an ces Wor kin g t o b r in g d ow n st at e an d local silos

What are the local ne eds?

T H E F L E T C H E R G R O U P F O R R E C O V E R Y H O U S ING

All politics are local – Tip O’Neill, Speaker, House of US Representatives, 1977-1987

IDAH AHO T TAR ARGET COUNTIES ES Bonner (44,727) Payette (23,551) Washington (10,161) TOTAL 368, 368,977

Oregon

TARGET C COUNTIES ES Baker (16,006) Grant (7,176) Harney (7,329) Malheur (30,725) Umatilla (77,516) Union (26,461) Wallowa (7,081) TOTAL 171, 171,271

WASH SHINGTON TARGET C COUNTIES ES Clallam (76,737) Grays Harbor (73,901) J efferson (31,729) Pacific (22,036) TOTAL 204, 204,403

MONTAN ANA A TARGET C COUNTIES ES Flathead (102,106) Gallatin (111,876) Lake (30,250) Lewis and Clark (68,700) Mineral (4,316) Park (16,736) Silver Bow (34,993) TOTAL 368, 368,977

KENTUCKY TARGET ET CO COUNTIES

Adair (19,215) Bath (12,383) Bell (26,569) Boyle (30,100) Breathitt (12,726) Carroll (10,737) Carter (27,004) Casey (15,888) Clay (20,105) Clinton (10,206) Cumberland (6,659) Elliott (7,508) Estill (14,198) Floyd (35,845) Garrard (17,560) Grayson (26,321) Green (11,049) Harlan (26,409) Hickman (4,421) J

• hnson (22,386)

Knott (15,126) Knox (31,304) Laurel (60,669) Lawrence (15,571) Lee (7,033) Leslie (10,143) Letcher (21,899) Lewis (13,257) Lincoln (24,644) McCreary (17,408) Magoffin (12,362) Martin (11,323) Menifee (6,451) Mercer (21,774) Monroe (10,718) Owsley (4,472) Perry (26,092) Pike (58,402) Powell (12,442) Robertson (2,135) Rockcastle (16,750) Russell (17,821) Taylor (25,549) Wayne (20,468) Wolfe (7,177)

• TOTA

TAL 88 884,909 4,909

OH OHIO T O TARGET COUNTIES ES Adams (27,724) Athens (65,818) Clinton (42,057) Galia (29,979) Highland (43,058) J ackson (32,384) Meigs (23,106) Pike (28,067) Scioto (75,502) Vinton (13,139) TOTAL 380, 380,834

WEST V VIR IRGIN INIA IA TARGET ET CO COUNTIES Braxton (14, 089) Calhoun (7,254) Greenbrier (34,786) J ackson (28,706) Logan (32,607) McDowell (18,223) Mason (26,718) Mercer (59,131) Mingo (23,785) Monroe (13,280) Nicholas (24, 842) Roane (13, 932) Summer (12,760)

TOTAL 368, 368,977

GE GEORGI GIA T TARGE GET COUNTIES ES Chattooga (24,790) Elbert (19,120) Fannin (25,964) Franklin (23,023) Gordon (57,685) Hart (265,099) Polk (26,099) Raburn (42,470) TOTAL 235, 235,018

Where Will ill Each Target ed St a t at e t e Be Be In T Three e Yea ear s?

CAPACITY

increased capacity to provide services addressing SUDs.

HOUSIN G

At least one new Recovery Residence.

PRIDE

A community-wide sense

• f progress in meeting

the challenges posed by the opioid epidemic.

Next Steps

STEP 1

Engage and collaborate with existing stakeholders.

STEP 2

Identify needs and tailor efforts to each com m unity.

STEP 3

Engage sponsors, including not-for-profits, provider groups and faith-based

• rganizations.

Next Steps

STEP 4

Obtain the support of the Governor, the governor’ s adm inistration and state housing authorities.

STEP 5

Select a site for the first Recovery Residence.

STEP 6

Apply the Fletcher Group’ s expertise in prevention, intervention, MAT, and Recovery Housing.

St a t at e t e Part rt ners rs

DEPARTM ENT OF CORRECTIONS STATE HOUSING CORPORATION (HUD) STATE DEPARTM ENT FOR LOCAL GOVERNM ENT CABINET FOR FAM ILIES AND CHILDREN

NOT IN MY BACKYARD?

REM IN D OBJECTORS WHO PEOPLE w i t h SUD ARE— YOUR N EIGHBORS, YOUR FRIEN DS, YOUR FAM ILY.

OU OUR FACI L I LI T I TI ES

W.A .A.R .R.M .M.

Women en's A Addict ion R Rec ecover ery Cen ent er er i in H Hen ender erson

• 28,757 county residents
• The first recovery facility in the state of Kentucky
• Frequently accepts residents from Tennessee

MISSI SSION

Provide hope to homeless women suffering from alcoholism and drug addiction.

M T M T—M OTI TIVATION AL TR TRACK PHASE SE O ON E—TRAN SI SITION AL P PHASE SE PHASE SE O ON E SO SOS—SAFE O E OFF THE S E STREET EETS

TEST STI M ON I ALS

What Our Clients Say

How Debt-Free Construction Works

How $5.9 million in construction costs were covered at the Regional Men's Recovery Center in Owensboro, Kentucky

$5,000,000

LIHTC (OVER 10 YEARS)

$250,000 $150,000 $500,000

1

HOME FUNDS

2

AFFORDABLE HOUSING TRUST

3

FEDERAL HOME BANK LOAN

4

How Operational Day-To-Day Sustainability Works

How $1.3 million in annual day-to-day operating costs are covered at the Men's Addiction Recovery Center in Bowling Green, Kentucky

$550,000

DEPARTMENT OF CORRECTIONS

$200,000 $300,000 $150,000 $100,000

1

HOUSING CHOICE VOUCHERS

2

COMMUNITY DEVELOPMENT BLOCK GRANTS

3

FOOD STAMPS (SNAP)

4

LOCAL

5

• Medication-Assisted Treatment

(MAT) is a form of pharmacotherapy and refers to any treatment for an SUD that includes a pharmacologic intervention as part of a comprehensive substance abuse treatment

• A meta-analysis of multiple studies documented significant

improvements in mortality rates with both methadone and buprenorphine.

• “Despite an exhaustive and systematic search, the small

number of studies that report on outcomes of interest and the weaknesses in the body of evidence prevent any strong conclusions about the effects of MAT on functional outcomes

• r differences in effects among medication types, route of

administration, treatment modality, or length of treatment.”

• No overall benefit to adding drug counseling to

buprenorphine-naloxone and weekly medical management.”

Overview Evidence

MAT

• https://www.bmj.com/content/357/bmj.j1550
• Maglione, M.A., et al Effects of Medication Assisted Treatment (MAT) for Opioid Use Disorder on Functional Outcomes: a

Systematic Review. (2018) RAND National Defense Research Institute. https://www.rand.org/pubs/research_reports/RR2108.html

• Weiss, RD and Rao, V The Prescription Addiction Treatment Study: What have we learned. Drug and Alcohol Dependence 173”

(2017) https://ac.els-cdn.com/S0376871617300029/1-s2.0-S0376871617300029-main.pdf?_tid=ae502d7a-ca19-11e7-804e- 00000aab0f27&acdnat=1510759911_69cedcc11b88b80cc78372fdc82eedef Accessed 11-15-17

• See also, David A. Fiellin, M.D., V. Pantalon, Ph.D., Marek C. Chawarski, Ph.D., Brent A. Moore, Ph.D., Lynn E. Sullivan, M.D.,

Patrick G. O’Connor, M.D., M.P.H., and Richard S. Schottenfeld, M.D. Counseling plus Buprenorphine–Naloxone Maintenance Therapy for Opioid Dependence New England Journal of Medicine 355;4 www.nejm.org July 27, 2006 pp 365-374 http://www.nejm.org/doi/pdf/10.1056/NEJMoa055255 Accessed 11-15-17

MAT References

http://www.oxfordhouse.org/userfiles/file/purpose_and_structure.php SAMHSA NREPP, “Intervention Summary: Oxford House Model,” https://nrepp.samhsa.gov/Legacy/ViewIntervention.aspx?id=223.

• Democratically run, self-supporting and

drug free home. The number of residents in a House may range from six to fifteen; there are houses for men, houses for women, and houses which accept women with children.

• Oxford House has been evaluated in a two-

year randomized, clinical trial which reported a significant reduction in substance use, increases in “self-control,” increases in employment, and reduced criminal justice involvement.

Overview Evidence

Oxford House

Social Recovery with Housing Supports

Logan, T., Miller,J., Cole, J., and Scrivner, A. (2018). Findings from the Recovery Center Outcome Study 2018 Report. Lexington, KY: University of Kentucky, Center on Drug and Alcohol Research

• Social Recovery model combines supportive housing with structured

education and focused reliance on a mutual-help 12-step program.

• Programs are overseen by professional staff, this mutual-help recovery

model utilizes peer mentors and peer role models.

• Program curriculum includes community meetings among the participants
• f the facility, and a structured educational program.

Recovery Kentucky

Social Recovery with Housing Supports

“The program changed me and I’m now a peer m entor. I know about this disease better and have the tools to stay sober.” “They truly, honestly care about m e and want m e to have a fruitful and productive future.”

“It changed my life. I learned from others and got a lot out of the program .” “They’ re personal and really care about you while you’ re there and when you go hom e.“

David Johnson, MSW, ACSW

CEO, Fletcher Group djohnson@fletchergroup.org

THANK YOU

Cont a t act t Infor m at ion

EM AIL ADDRESS

info@fletchergroup.org

PHON E N UM BER

(406) 360-0767

M AILIN G ADDRESS

950 Eagles Landing Parkway, Suite 584 Stockbridge, Georgia,30281