Presenters DAVE JOHNSON MSW, ACSW fletchergroup.org Project - - PowerPoint PPT Presentation

▶
presenters
SMART_READER_LITE
LIVE PREVIEW

Presenters DAVE JOHNSON MSW, ACSW fletchergroup.org Project - - PowerPoint PPT Presentation

Apr 08, 2023 109 likes •914 views

ERNIE FLETCHER,MD Principal Investigator Presenters DAVE JOHNSON MSW, ACSW fletchergroup.org Project Administrator This presenta,on is supported by the Health Resources and Services Administra,on

slide-1
SLIDE 1

Presenters

ERNIE FLETCHER,MD

Principal Investigator

DAVE JOHNSON MSW, ACSW

Project Administrator

fletchergroup.org

This ¡presenta,on ¡is ¡supported ¡by ¡the ¡Health ¡Resources ¡and ¡Services ¡Administra,on ¡(HRSA) ¡of ¡the ¡U.S. ¡Department ¡of ¡Health ¡and ¡Human ¡Services ¡(HHS) ¡as ¡part ¡of ¡an ¡award ¡ totaling ¡$10.4 ¡million. ¡The ¡contents ¡are ¡those ¡of ¡the ¡author(s) ¡and ¡do ¡not ¡necessarily ¡represent ¡the ¡official ¡views ¡of, ¡nor ¡an ¡endorsement, ¡by ¡HRSA, ¡HHS ¡or ¡the ¡U.S. ¡Government. ¡
slide-2
SLIDE 2

Our Goal Today

To ¡start ¡you ¡on ¡a ¡path ¡to ¡a ¡ Recovery ¡Residence ¡that ¡is: ¡

  • ¡Safe ¡
  • ¡Effec,ve ¡
  • ¡Affordable ¡
  • ¡Sustainable ¡
slide-3
SLIDE 3

AGENDA

  • 1. The Fletcher Group RCOE
  • 2. Providing Scientific and Technical

Assistance

  • 3. Recovery Housing Overview
  • 4. Idaho and SUDs
  • 5. Outcomes
  • 6. Recovery Housing in Idaho
slide-4
SLIDE 4

To reduce morbidity, mortality, and other adverse outcomes associated with Substance Use Disorders,

particularly Opioid Use Disorders in

rural communities

where guidance is needed to address not only the current opioid crisis, but future crises as well.

HRSA Mandate

slide-5
SLIDE 5

INTERVENTION

  • Prevention programs
  • Early intervention,

especially SBIRT

SURVEILLANCE

  • SUD/OUD screening

and diagnosis

  • Fatal and nonfatal
  • verdoses
  • Service availability,

including MAT

HOUSING

  • Recovery Housing

NARR Levels 1-4

  • National Recovery

Housing Directory

  • Training Portal
  • Outcomes Portal

HRSA TARGETS

slide-6
SLIDE 6

OUR PARTNERS

slide-7
SLIDE 7
  • DR. TERRY BUNN

UK Associate Professor and KIPRC Director

Our Co-Investigator

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

slide-8
SLIDE 8

Our History

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.

slide-9
SLIDE 9

Our Culture

TEAM-ORIENTED

Partnerships—federal, state and private sector.

COMMUNITY EMPHASIS

Local understanding, buy-in, and support.

FLEXIBLE

Agile and purpose-driven.

slide-10
SLIDE 10

Collaborating

To Integrate Silos

PARTNERING

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

INTEGRATING WITH STAKEHOLDERS

Integrate with community efforts, not rebuild.

NON-COMPETITIVE

Who gets the credit?

slide-11
SLIDE 11

A NATIONAL AND TARGETED REACH

We work in rural communities in Montana, Idaho, Washington, Oregon, Kentucky, Georgia, West Virginia, Ohio, and other rural communities as requested

VULNERABLE POPULATIONS

We focus on the homeless and those with SUDs involved with criminal justice.

Our Focus

Recovery Housing

slide-12
SLIDE 12

EVERYTHING FROM “SOUP TO NUTS”

  • Provide scientific and

technical assistance

  • Disseminate Best Practices

to rural communities

  • Help sustain all four NARR

levels of Recovery Housing

Fletcher Group Technical Assistance

slide-13
SLIDE 13

ONE VOICE

We work hand-in-hand with NARR and

  • ther partners to ensure a nationally

unified voice for Recovery Residences.

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

slide-14
SLIDE 14

“I really liked the recovery dynamics. They explained the disease. They show a lot of love and teach you how to love yourself and others.” “The program deals with my addiction in a productive way. It gives me structure and the tools I need to stay sober.”

TESTIMONIALS ¡

slide-15
SLIDE 15

The Challenges

CONFUSION

Desperate families spend thousands of dollars with little to show.

LACK OF RESOURCES

Rural communities lack the funds, providers and resources to respond.

CHAOS

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

slide-16
SLIDE 16

RECOVERY ¡RESIDENCES ¡IN ¡THE ¡CONTINUUM ¡OF ¡RECOVERY ¡

NARR Levels Of Support

slide-17
SLIDE 17

RECOVERY ¡RESIDENCES ¡IN ¡THE ¡CONTINUUM ¡OF ¡RECOVERY ¡

Four Distinct Levels

slide-18
SLIDE 18
  • In 2018 over 68,000 overdose

deaths were reported, with 60% resulting from opioid overdoses.

  • Many occurred soon after

release from prison.

  • A holistic approach takes a

community view to address individuals impacted by substance use disorders.

Establishing A Recovery Ecosystem

THE NEED FOR A HOLISTIC APPROACH

slide-19
SLIDE 19

Challenges Unique To Rural Areas

HIGHER COSTS

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

HIGHER RATES

  • f SUD incidence, morbidity,
  • verdose occurrence and

mortality.

FEWER RESOURCES

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

GREATER STIGMA

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

slide-20
SLIDE 20

Local community efforts Integrate with existing efforts State efforts and strategy Bring down silos and inform RH strategies

“All ¡poli(cs ¡are ¡local.” ¡

Tip ¡O’Neill, ¡Speaker, ¡House ¡of ¡US ¡Representa8ves, ¡1977-­‑1987 ¡

Top Down Versus Bottom Up

slide-21
SLIDE 21

IDAHO

CHALLENGES

slide-22
SLIDE 22

IDAHO TARGET COUNTIES Payette (23,551) Washington (10,161) TOTAL: 33,712

slide-23
SLIDE 23

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

slide-24
SLIDE 24
slide-25
SLIDE 25
slide-26
SLIDE 26
slide-27
SLIDE 27

54%

OF THE HOMELESS HAVE A SUBSTANCE USE DISORDER

Source: Homelessness in Idaho 2015 Point In Time Count (2015)

slide-28
SLIDE 28
slide-29
SLIDE 29
slide-30
SLIDE 30
slide-31
SLIDE 31
slide-32
SLIDE 32
slide-33
SLIDE 33
slide-34
SLIDE 34
slide-35
SLIDE 35
slide-36
SLIDE 36
slide-37
SLIDE 37
slide-38
SLIDE 38

Unique Rural Challenges

HIGHER COSTS

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

HIGHER RATES

  • f SUD incidence, morbidity,
  • verdose occurrence and

mortality.

FEWER RESOURCES

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

GREATER STIGMA

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

slide-39
SLIDE 39

Unique Cultural Challenges

GEOGRAPHY

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

COMPLEXITY

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

VULNERABLE

More Native Americans meet the diagnostic criteria for SUD than any other ethnic

  • r minority group.

DISTRUST

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

slide-40
SLIDE 40

NATIVE AMERICAN

CHALLENGES

slide-41
SLIDE 41

12.3%

OF AMERICAN INDIANS CURRENTLY USE ILLICIT DRUGS

Source: National Survey on Drug Use and Health (compared to 9.5% of whites, 8.8% of Hispanics, and 10.5% of African Americans)

slide-42
SLIDE 42

#1

HIGHEST INCREASE IN OVERDOSE MORTALITY IS AMONG NATIVE AMERICANS

Source: Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, Dec. 21, 2018 (specifically drug- and opioid-involved overdose mortality)

slide-43
SLIDE 43

2.7 TIMES HIGHER

MORTALITY RATE AMONG NATIVE AMERICANS COMPARED TO WHITES

Source: Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, Dec. 21, 2018 (In Washington State 2013-2015; nationwide data unavailable)

slide-44
SLIDE 44

4.1 TIMES HIGHER

HEROIN-INVOLVED OVERDOSE MORTALITY

Source: Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, Dec. 21, 2018 (2013-2015)

slide-45
SLIDE 45

40%

ESTIMATED PERCENTAGE BY WHICH NATIVE AMERICAN MORTALITY RATES ARE UNDERESTIMATED

Source: Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, Dec. 21, 2018

slide-46
SLIDE 46

NOT IN MY BACKYARD?

REMIND OBJECTORS WHO ADDICTED PEOPLE ARE— YOUR NEIGHBORS, YOUR FRIENDS, YOUR FAMILY.

slide-47
SLIDE 47

OUR FACILITIES

slide-48
SLIDE 48

W.A.R.M.

Women's Addiction Recovery Center in Henderson

  • 28,757 county residents
  • The first recovery facility in the state of Kentucky
  • Frequently accepts residents from Tennessee
slide-49
SLIDE 49

MISSION

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

slide-50
SLIDE 50

Recovery Center

WARM Residences I 32 units W A R M R e s i d e n c e s I I 32 units

C

  • m

m u n i t y C e n t e r

slide-51
SLIDE 51

HICKORY HILLS RECOVERY CENTER

Knott County, Kentucky 15,126 county residents Overdose Rate: 44 per 100,000 The CDC’s 17th Most Vulnerable County

slide-52
SLIDE 52

PROGRAM

Peer-to-peer self-help including the 12-step AA program used to develop the personal accountability, self-actualization, and empowerment needed to re- enter into relationships, work, and society.

slide-53
SLIDE 53

MT—MOTIVATIONAL TRACK PHASE ONE—TRANSITIONAL PHASE PHASE ONE SOS—SAFE OFF THE STREETS

slide-54
SLIDE 54

TESTIMONIALS

What Our Clients Say

slide-55
SLIDE 55

“The program changed me and I’m now a peer

  • mentor. I know about this disease better and

have the tools to stay sober.” “They truly, honestly care about me and want me to have a fruitful and productive future.”

slide-56
SLIDE 56

“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 home.“

slide-57
SLIDE 57
slide-58
SLIDE 58

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

slide-59
SLIDE 59

WHAT'S LIHTC?

The Low-Income Housing Tax Credit is the key to debt-free construction. INVESTOR

Investors address tax liability by acquiring tax credits (investors can include banks)

FEDERAL GOVERNMENT

Wants to help low-income residents live in a decent home

STATE HOUSING AUTHORITY

Administers program by issuing annual tax credits for ten years to developers of worthy projects

DEVELOPER

Can cover most construction costs by passing annual tax credits to the investor

COMMUNITY

Win-win for the project, the residents, the investor, construction workers and the local economy

slide-60
SLIDE 60

WHAT’S A QAP?

A Qualified Allocation Plan (Set Aside) Housing Authority

Every one to two years to develop scoring criteria

Public Comment

Opportunity to influence scoring criteria

Application

Putting together a competitive bid for tax credits

Pay Back

Documenting financial ability to sustain

  • perations

Operations

Residents documented who meet HUD criteria

slide-61
SLIDE 61

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

slide-62
SLIDE 62

Potential Partners

WE'RE IN THIS TOGETHER

  • Departments of Community Health
  • Departments of Corrections
  • Departments of Behavioral Health and

Development Disabilities

  • Departments of Community Affairs
  • Housing Authorities
  • Faith-Based
  • Private Sector employers and others
slide-63
SLIDE 63

RECOVERY KENTUCKY

THE BASICS

  • 100 bed facility in one 38,000 sq. ft. building
  • Social model based on 12-Steps AA Program
  • 6-9 month stay

DEVELOPMENT FUNDS

  • LIHTC, FHLB, HOME, State and Federal Trust

Funds

RENTAL FUNDS

  • Project Based Section 8

SUPPORTIVE SERVICE FUNDS

  • State department of corrections for 50% of units
  • Community Development Block Grant Funds
  • Food stamps/SNAP from participants
slide-64
SLIDE 64

BLENDED FUNDING

slide-65
SLIDE 65

SITE SELECTION ISSUES

  • Supportive of city and jobs
  • 3.5-5.0 acres
  • Flat or convertible to flat
  • Zoning should be multi-family, but check local

guidelines

  • Do not discount NIMBY-ism (“Not in my

backyard”)

  • Available water, sewer, electric, and highway

access

  • Walk-able to class and “trudging-friendly”
  • Sellers ability to sell
  • Environmental issues
  • Sub-surface conditions
  • Drainage
  • Easements
slide-66
SLIDE 66

LIHTC BASICS

LOW-INCOME HOUSING TAX CREDITS

  • A federal program
  • Administrated by states
  • Competitive process, but there may be set-asides
  • Each state’s annual credit allocation is approximately

$2.50/person multiplied by the state’s population

  • Example: A 100-bed recovery residence would need

approximately $1.1 million in credit allocation

slide-67
SLIDE 67

CONSTRUCTION CONSIDERATIONS

  • Construction usually takes one year
  • State construction requirements can

substantially affect cost

  • Project-based Section 8 assistance will trigger

Davis Bacon wage requirements

  • Section 8 will provide rental assistance only for

units occupied by one individual

  • Individual units designed with kitchen facilities,

(section 8 requirements) but kitchen is not used

  • Individual units need to have potential to be

efficiency unit as a back up plan for syndicators

slide-68
SLIDE 68

PRELIMINARY WORK

6 MONTHS BEFORE APPLICATION

  • Identify resources for development
  • Conceptual physical plan and engage architect
  • Preliminary financial proforma
  • Identify real estate
  • Project must meet requirements of state’s

qualified allocation plan

  • Identify players

AT TIME OF APPLICATION

  • Submit LIHTC application
  • Submit application for other funding

4 MONTHS AFTER APPLICATION

  • Application approval and closing documentation
slide-69
SLIDE 69

CLOSING REQUIREMENTS

CLOSING DOCS—6 MONTHS AFTER APPLICATION Complete and submit plans for approval Prepare partnership agreement Loan agreements Secure all development and operating financial commitments Section 8 environmental reviews secured CLOSING—10 MONTHS AFTER APPLICATION Section 8 Housing Assistance payment contract Detail plan of development funds cash flow Sponsor may need to bring guarantee to table LIHTC carryover allocation Execute partnership agreement Close construction loans

slide-70
SLIDE 70

CONSTRUCTION BEGINS

12 MONTHS AFTER APPLICATION

  • Payments of construction funded by equity draws

and construction loan

  • Process change orders
  • Closely monitor timing to make credit delivery
  • Keep accurate accounting records for

development and construction funds

  • Monthly inspections by state, syndicators and

project architect

20 MONTHS AFTER APPLICATION

  • Rental agent and social service providers

preparing for completion

slide-71
SLIDE 71

CONSTRUCTION COMPLETED

24 MONTHS AFTER APPLICATION

  • Cost certification
  • Final survey
  • Certificate of occupancy
  • Radon Testing
  • Final Inspections
  • Section 8 inspections
  • First class move in
slide-72
SLIDE 72

POST- COMPLETION

30 MONTHS AFTER APPLICATION

  • Retire construction loan
  • Submit close out documents to State Housing

Finance Agency

  • Close with other funding sources
  • Receive completion equity
  • Complete occupancy of project

1ST TAX YEAR

34 - 36 MONTHS AFTER APPLICATION

  • Receive form 8609 from State Housing Finance

Agency

  • Prepare income tax return for 1st tax credit

delivery year

slide-73
SLIDE 73

SUGGESTED ORG CHART

slide-74
SLIDE 74

LIFE SKILLS SCHEDULE

slide-75
SLIDE 75

SUGGESTED DAILY ROUTINE

slide-76
SLIDE 76

Next Steps

STEP 1

Engage and collaborate with existing stakeholders.

STEP 2

Identify needs and tailor efforts to each community.

STEP 3

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

  • rganizations.
slide-77
SLIDE 77

Next Steps

STEP 4

Obtain the support of the Governor, the governor’s administration 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.

slide-78
SLIDE 78

Thank you! Questions?

slide-79
SLIDE 79

Contact Information

DAVE JOHNSON, MSW, ACSW Project Administrator djohnson@fletchergroup.org WEBSITE fletchergroup.org ERNIE FLETCHER, MD Principal Investigator efletcher@fletchergroup.net