Strategies to Ensure Quality Recovery Housing David Sheridan President, National Alliance for Recovery Residences Tom Hill VP, Practice Improvement National Council for Behavioral Health May 23, 2018 Bethesda MD

Continuum of Addiction Recovery/Stages of Change Recovery Initiation & Stabilization Pre-Recovery Engagement Recovery Maintenance Long-term Recovery Adapted from William White Pre-contemplation  Contemplation  Preparation  Action  Maintenance Prochaska & DiClemente

Recovery Capital In assisting people to achieve long-term recovery, it is essential to help them assess and build their Recovery Capital. Recovery Capital is the sum of the strengths and supports – both internal and external – that are available to a person to help them initiate and sustain long-term recovery from addiction. (Granfield and Cloud, 1999, 2004; White, 2006)

Creating and Reinforcing Individual Recovery Capital Essential Ingredients for Sustained Recovery: Safe and affordable place to live Steady employment and job readiness Education and vocational skills Life and recovery skills Health and wellness Recovery support networks Sense of belonging and purpose Community and civic engagement

Recovery Ecologies Community Recovery Capital Treatment Options Jobs and Job Readiness What this means is that at a systems level, it is meaningful to conceptualize and measure recovery capital as the sum of resources and supports available to people starting recovery journeys. Recovery Community Center Legal Assistance Recovery Housing Recovery High School Collegiate Recovery Program Mutual Aid Peer Support Health, Nutrition, & Fitness Best & Laudet, 2013

Basic information Founded in 2011 National standard, code of ethics Taxonomy of the spectrum of recovery housing nationally Affiliate relationships in 28 states, others forming (one per state) Referenced in: The Surgeon General’s report Facing Addiction: Alcohol, Drugs, and Health (2016), President’s Commission on Combating Drug Addiction and the Opioid Crisis. (2017) NARR standards included in Congressional legislation this term

Basic information Training, technical assistance Operating model for statewide recovery housing support systems Working relationships with state agencies Referenced in Indiana, Rhode Island state law Testimony before the New York State Senate task force on Heroin and the Opioid Crisis Developing policy and provider guides to MAT in recovery housing

NARR at a glance 27 affiliates 3 in development

Classification: Levels of recovery support

Classification: Levels of recovery support Treatment “Oxford House” “Sober Living Home” Terms vary

Recovery residences: Enter at any level Recovery process duration Recovery housing in the continuum of recovery Acute care (ER, detox, residential treatment) High Recovery residences: Enter at any level Level 4 Level 3 Service intensity Level 2 Level 1 Low Stabilization Long-term recovery: Independent, meaningful living in the community Recovery process duration

Features of the standards Covers the full spectrum of recovery housing, from Oxford Houses to residential programs with clinical services Standard is specific to the level of recovery support a residence provides Supports multiple recovery pathways Achievable by low-cost providers Supports medication-assisted treatment in an abstinence framework Comprehensive: Includes health & safety, recovery support environment, operations, financial disclosures, ethics, good neighbor policies

Attributes of a successful recovery housing system Basic elements Standards, ethics Formal process of residence evaluation, certification Training, technical assistance Resolution of complaints Integration into health care, other systems Relationship building and management Connections to health care, other support systems Collaboration with other agencies

Attributes of a successful recovery housing system System effectiveness Capacity assessment, planning Recognition, incentives for certification, compliance Investigate best practices from other states’ experience Consumer, public awareness Financial support Access to residence services by individuals in need (most capacity is self-pay) Funding for the certification and support system Capital for capacity expansion, property renovations

Attributes of a successful recovery housing system Other important elements Measured outcomes: recovery, health, access, other metrics Continuous quality improvement Address fraud and abuse Fair housing protections

In Your Hands: Recovery Housing Toolkit A joint effort between National Council and NARR with input from other stakeholders, including Oxford House. Provides state policymakers and advocates strategies, tools, and policy language that support the infrastructure of recovery housing, quality operating standards, and protections for people in recovery. Highlights three main sections: Protecting Recovery Housing Supporting Recovery Housing in Practice Sample Legislative Language

Recommendations: Definitions and Standards Adopt a definition of recovery housing that includes the core functions of recovery housing. Recommended terms: “recovery housing” or “recovery homes” because they most closely reflect the values and structure outlined in the definitions.  Reference nationally-recognized recovery housing quality standards in the establishment a recovery housing certification program.

Recommendations: Financial Incentives 3. Incentivize the adoption of recovery housing quality standards by requiring referrals be made to houses meeting established standards. 4. Incentivize the adoption of standards by making state and local funds only available to houses meeting established standards.

Specific Recommendations: Public Awareness 5. Engage public communication efforts with the general public, people in recovery, and providers. Create a public registry of certified recovery homes in the state. The registry should be updated in real time and include information on available vacancies.

Recommendations: Expanding Access 6. Invest in training and technical assistance opportunities for recovery housing operators and staff. Training should be provided by the state’s Oxford House™ or NARR affiliate.. 7. Invest in a NARR affiliate organization and/or Oxford House™ partner to operationalize the recovery housing quality standard certification process. 8. Support recovery housing as a required element of the continuum of care for individuals with substance use disorders in every local community.

What’s Next? Emerging Policy MAT-Friendly Housing: Expect federal and state administrators to push for more housing that accepts residents on all forms of medication-assisted treatment (MAT) State Fraud and Abuse Bills: Following Florida’s example to legislate against patient brokering between treatment providers and recovery homes, other states bills are in the hopper (CA, UT, IL) Federal Legislation: Some Members of Congress have introduced bills to encourage or mandate federal recovery housing standards.

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NARR is here to help. Contact us for more information. Narronline.org Email: info@narronline.org David Sheridan dave.sheridan@narronline.org Tom Hill tomh@thenationalcouncil.org