1. 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

2. 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

3. 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)

4. 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

5. 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

6. 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

7. 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

8. NARR at a glance
27 affiliates
3 in development

9. Classification: Levels of recovery support

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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

22. Annual Conference
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23. NARR is here to help. Contact us for more information.
Narronline.org
David Sheridan
Tom Hill