Difference between revisions of "Improve Recovery Housing"

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=Introductory Paragraph=
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]&nbsp;or [[ZOOM_MAP_-_Improve_Treatment_&_Enable_Recovery_for_People_with_SUDs|ZOOM MAP - Improve Treatment & Enable Recovery of People with SUDs]]&nbsp;or [[ZOOM_MAP_-_Strengthen_Peer_Recovery_Support_Services_&_Programs|ZOOM MAP - Strengthen Peer Recovery Support Services & Programs]]<br/> __TOC__<br/> <br/> People who are&nbsp;in and recenttly coming out of treatment often struggle to find safe, affodable, and supportive housing options.&nbsp; Without this basic need being met, the chances that someone in recovery - especially early recovery - will experience relapse&nbsp;increase greatly.&nbsp;Homelessness, returning to stay with friends who still use, or staying in another situation that does not support recovery often results in relapse.&nbsp; When relapse takes place typiclly many more community resources are required to help the individual to recieve emergency health care, social services, treatment, and other costs related to addressing Substance Use Disorder.&nbsp;&nbsp;<span style="background-color: transparent; color: #000000; font-family: arial,helvetica,sans-serif; font-size: 13px; text-decoration: none">Dr. Rachel Solatra says that people in shared recovery housing are three times as likely to complete treatment.</span><sup class="reference">[1]</sup><br/> <br/> There can be many types of supportive housing or recovery housing, and the quality and attributes of the recovery housing can have a major impact on the success of the person in recovery. There are&nbsp;instances of "bad actors" in recovery housing that are part of schemes like the "Florida Shuffle" (get link to info) and where the best interest of the person in recovery is not important.&nbsp; It is therefore important for individuals and communities to ensure recovery housing options are reputable and have the best interests of their residents in mind.<br/> <br/> Supportive Housing for people in recovery can range from peer-run homes to licensed treatment programs.__NOTOC__


= Background Information on Recovery Housing =
Recovery housing is a highly individualized choice based on a variety of needs. For those seeking recovery housing, finding safe, affordable, and supportive housing options can be difficult. There are many types of housing in different settings and different levels of care. Supportive housing for people in recovery can range from peer-run homes to licensed treatment programs. It is important for individuals and communities to ensure recovery housing options are reputable and have the best interests of their residents in mind.
<div class="_">Each year, over two million people in the United States participate in alcohol or other drug treatment programs. Research has shown that the longer a person remains in a treatment or recovery environment, the greater are her or his chances of sustaining long-term recovery. Many treatment programs are 30 to 60 days long, which means that people in the early stages ofrecovery are often discharged from programs only to return to environments where alcohol or other drug use triggers abound. Recovery residences can provide a vital bridge from in-patient or institutional treatment to recovery communities and independent living. Long after discharge from treatment, recovery residences can assist people by providing a safe, healthy place to live that focuses or re-focuses them on their recovery and reduces the triggers for substance misuse.<sup class="reference">[2]</sup></div> <div class="_">&nbsp;</div>
= Example of Innovations in Recovery Housing =


== Oxford House, Inc. ==
=Key Information=


[http://www.oxfordhouse.org Oxford House] is a concept and system of operations that supports behavior change and provides a stable, comfortable, long-term living environment that requires abstinence and builds self-sufficiency that supports successful long-term recovery. Oxford Houses are self-run and self-supported, so they are a scalable way to expand recovery housing. The Oxford House Manual(c) is a basic blueprint that provides the organization and structure that allow a group of recovering individuals to successfully live together in a supported environment in a rented home in a residential neighborhood where they share expenses. The residents self-manage the home, keeping the costs low and helping build skills needed for life. The original 13 Oxford Houses open in 1975 has grown to 2,287 houses with over 18,000 Oxford Recovery Beds (Dec. 31, 2017). Over 400,000 people have lived in Oxford Houses, and most have stayed clean and sober.<sup class="reference">[3]</sup> Many research studies have show the effectiveness of the Oxford House model, and it has been frequently recognized as both and evidence-based practice and a best practice. In the past, Oxford Houses did not allow residents to be on MAT, but according to the 2017 annual report, "Oxford House residents will generally accept individuals using MAT and some residents may encourage the MAT recipient to taper off the use of these drugs. All Oxford House residents will monitor MAT users to make certain they stay on their prescription."<sup class="reference">[4]</sup><br/> [[More_on_the_Oxford_House_Inc._model|More on the Oxford House Inc. model]]
SAMHSA defines recovery housing as "safe, healthy, family-like substance-free living environments that support individuals in recovery from addiction. While recovery residences vary widely in structure, all are centered on peer support and a connection to services that promote long-term recovery. Substance-free does not prohibit prescribed medications taken as directed by a licensed prescriber.” <ref>https://www.samhsa.gov/resource/ebp/recovery-housing-best-practices-suggested-guidelines.</ref>  


Oxford House also provides a database showing where there houses are located, vacancies, and other useful information for anyone looking to join and Oxford House:
There are a variety of types of recovery home certifications and credentials:
* '''The National Alliance for Recovery Residences (NARR)''' is a 501(c)3 nonprofit organization dedicated to expanding the availability of well-operated, ethical, and supportive recovery housing. NARR offers recovery homes with a suite of options for certification. <ref>https://narronline.org</ref>
* '''The Commission on Accreditation of Rehabilitation Facilities (CARF)''' is an independent, non-profit accreditor providing accreditation services worldwide at the request of health and human service providers. CARF accreditation demonstrates a provider's commitment to enhance its performance, manage its risk, and distinguish its service delivery. <ref>http://www.carf.org</ref>
* '''Oxford Houses''' are self-run and publicly supported. A 501(c)3 corporation serves as an umbrella organization connecting networked Oxford Houses. It also allocates resources to duplicate their model. <ref>https://oxfordhouse.org</ref>
* '''Independently-Owned and Operated Homes''' Recovery homes may also be independently owned and operated as a small business outside of an existing credentialing network - offering flexibility and ease of admission. These homes are often peer-led, allowing the residents to provide mutual support to one another and become financially self-sufficient. Although independently-owned recovery houses do not provide on-site licensed professional services, they often have resources and relationships with local recovery support professionals. Even though independently owned recovery homes do not hold a license or formal certification, they conform to local zoning and building safety codes for residential occupancy.


[https://www.oxfordvacancies.com/ https://www.oxfordvacancies.<wbr></wbr>com]
Note: States may have independent certification or credentialing requirements. Please check the recovery residence certification guidelines within your own state for more information.


&nbsp;
=Relevant Research=


== National Alliance for Recovery Residences (NARR) ==
'''The National Council for Behavioral Health''' documents research findings which detail the benefits recovery housing has provided to individuals in obtaining and maintaining long-term recovery. These include: <ref>https://narronline.org/wp-content/uploads/2017/09/Recovery-Housing-Issue-Brief_May-2017.pdf</ref>


The National Alliance for Recovery Residences, or NARR ([http://narronline.org/ [1]]) is a 501-c3 nonprofit and recovery community organization (RCO) that currently serves 25 regional affiliate organizations. These affiliate organizations collectively support over 25,000 persons in addiction recovery who are living in over 2,500 certified recovery residences throughout the United States.
* Reduced risk of relapse/recurrence
* Lower rates of incarceration and recidivism
* Higher income
* Increased employment
* Improved family relationships
* Overall higher recovery capital


&nbsp;
'''“Understanding Challenges for Recovery Homes during COVID-19.”''' This article addresses the different ways that recovery homes altered their model and structure as a result of COVID-19. Recovery homes use a social model approach to recovery that contrasts with mitigation procedures such as social distancing and stay-at-home orders. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566762/</ref> Individuals residing in recovery housing are at a higher risk of contracting COVID-19 due to the group living environment. NARR has adopted the CDC guidelines and has applied them to recovery home settings. Recovery houses other than those with NARR certification that are licensed through the state also follow strict health and safety guidelines. Recovery homes that are independently licensed have less oversight.


== Portland Model using First Responders ==
=Impactful Federal, State, and Local Policies=


In Portland, first responders can direct people to recovery housing.<sup class="reference">[5]</sup><br/> &nbsp;
'''The 2018 SUPPORT Act (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment).''' In an effort to improve and expand recovery housing, Congress directed SAMSHA to collaborate with stakeholders and to facilitate the development of best practices for operating recovery housing.  These best practices may include model laws that seek to prevent relapse and overdose (including greater access to MAT), as well as the development of indicators that could be used to identify fraudulent recovery housing operators. <ref>https://www.samhsa.gov/sites/default/files/housing-best-practices-100819.pdf</ref>


&nbsp;
'''The National Council for Behavioral Health''' developed a set of policy recommendations for nationwide adoption and implementation of recovery housing. These can be found in the toolkit titled “Building Recovery State Policy Guide for Supporting Recovery Housing.” <ref>https://www.thenationalcouncil.org/wp-content/uploads/2018/05/18_Recovery-Housing-Toolkit_5.3.2018.pdf?daf=375ateTbd56</ref> In this guide, Alan Johnson, Florida Chief Assistant to the State Attorney, stated  “We recommend that states be given the ability to require certification under NARR (National Alliance for Recovery Residences) or similar standards, or other recognized programs such as Oxford House™ to protect the vulnerable residents living in sober homes.”


= Important Ways to Expand and Assure Quality of Recovery Housing =
'''SAFE Project''' maintains a list of current legislation on recovery housing by state. For more information please contact us at Community@safeproject.us.


SAMSHA Resource - Recovery Housing: Best Practice and Suggested Guidelines
=Available Tools and Resource=


In an effort to improve and expand recovery housing, Congress&nbsp;directed SAMSHA to collaborate with stakeholders and facilitate thee development of best practices for operating recovery housing.&nbsp; Authorized under the 2018 Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act, these best practices may include model laws that seek to prevent relapse and overdose (including greater access to MAT), as well as the development of indicators that could be used to identify fraudulent recovery housing operators.&nbsp; The full resource can be found at:
* '''SAMHSA''' provides a guide titled "Best Practices for Recovery Housing." <ref>https://store.samhsa.gov/sites/default/files/pep23-10-00-002.pdf</ref>


[https://www.samhsa.gov/sites/default/files/housing-best-practices-100819.pdf https://www.samhsa.gov/sites/default/files/housing-best-practices-100819.pdf]
*'''SAFE Project''' has a web page dedicated to recovery housing. <ref>https://www.safeproject.us/community/recovery-housing/</ref> It includes two downloadable resources. "A Community Case for Recovery Housing" addresses why communities should invest in recovery housing and covers seven concrete ways to support recovery housing. The "Choosing High-Quality Recovery Housing Workbook" provides information for individuals to make informed decisions on what recovery residence is best for them.


&nbsp;
* '''NARR''' hosts an annual summit on recovery housing, and its website offers a variety of resources and services. <ref>https://narronline.org/annual-summit/</ref>


Add points from the NARR Toolkit<br/> &nbsp;
* '''NASTAD''' provides recommendations and considerations for planning and starting a supportive housing program.  <ref>https://nastad.org/sites/default/files/2023-10/Resource-PDF-Housing-Program-Recommendations-and-Considerations-102323.pdf?utm_source=newsletter&utm_medium=email&utm_content=Thinking%20About%20Starting%20a%20Supportive%20Housing%20Program%3F%20Recommendations%20and%20Considerations%20for%20the%20Planning%20Process&utm_campaign=UA-179397308-1</ref>


&nbsp;
=Promising Practices=


= Innovations to Enhance Supportive Housing (Recovery Homes) =
*'''Oregon.''' Central City Concern (CCC) is a nonprofit that has worked in Portland since 1979. <ref>https://centralcityconcern.org/</ref> It is a national model for integrating services which relieve homelessness, deliver substance use treatment and recovery options, provide jobs, and promote health. At its inception, CCC was charged with funding local recovery and treatment providers and preserving Old Town’s housing stock. They bought and renovated the Butte Hotel and other historic buildings and currently manage over 30 affordable housing units in Portland. One of these is the Richard L. Harris Building (also known as the “8×8”) a 12-story alcohol- and drug-free community building located above CCC’s Old Town Clinic. A news clip titled "What First Responders in Portland, Oregon, Are Doing" highlights the way the Portland community at-large is working with CCC in its efforts to offer peer support, employment training and assistance, and an extended safe place for people to build their foundation of recovery.  <ref>https://www.nbcnews.com/nightly-news/video/portland-tackles-opioid-epidemic-with-community-paramedics-1227745347553</ref>


Housing is such an important part of supporting recovery that it is worth exploring ways to continue to make it better or the resident and the others in the neighborhood. Many of the practices of "best practice" approaches like the Oxford House were developed in the 1970s and 1980s with modest improvements in recent years. But, there are so many new tools and strategies that could be used to make recovery homes even better. Here are some options worth exploring.<br/> &nbsp;
=Sources=
 
&nbsp;
 
== Community Care Coordination software ==
 
Use of Community Care Coordination software to help developed a whole parson care strategy for each individual living in a recovery home.<br/> &nbsp;
 
&nbsp;
 
== Apps to Support Mental Health & Well-Being ==
 
Use of on-line platforms (apps) that help people address underlying mental health issues of anxiety, depression or trauma, such as MyStrength<br/> &nbsp;
 
&nbsp;
 
== Peer Support Apps ==
 
Use of peer recovery support tools like rTribe or DelightMe<br/> &nbsp;
 
&nbsp;
 
== Recovery Support Apps ==
 
Use of supportive technologies like Rezility or rTribe&nbsp;to enhance the recovery success of people living in the recovery homes.<br/> &nbsp;
 
&nbsp;
 
== Faith Community Social Support ==
 
Support by faith communities and non-profit organizations in social and health-related activities, including:<br/> &nbsp; Community Gardening<br/> &nbsp; Chess Clubs<br/> &nbsp; Men's Sheds<br/> &nbsp; Music<br/> &nbsp; Mentoring<br/> &nbsp; Job skill development and job-finding help<br/> &nbsp;
 
&nbsp;
 
== Home Rehabilitation, Repair and Remodeling ==
 
<br/> &nbsp;
 
= Tools & Resources =
 
[[TR_-_Improve_Supportive_Affordable_Housing_Options_for_People_in_Recovery|TR - Improve Supportive & Affordable Housing Options for People in Recovery]]
 
= Scorecard Building =
 
[[PO_-_Improve_Supportive_Affordable_Housing_Options_for_People_in_Recovery|Potential Objective Details]]<br/> [[PM_-_Improve_Supportive_Affordable_Housing_Options_for_People_in_Recovery|Potential Measures and Data Sources]]<br/> [[PA_-_Improve_Supportive_Affordable_Housing_Options_for_People_in_Recovery|Potential Actions and Partners]]
<div class="mw-parser-output">
= Resources to Investigate =
 
[[RTI_-_Improve_Supportive_&_Affordable_Housing_Options_for_People_in_Recovery|More RTI on Improve Supportive & Affordable Housing Options for People in Recovery]]<br/> [https://www.behavioral.net/article/policy/gao-report-finds-haphazard-approaches-overseeing-recovery-homes [2]]
 
&nbsp;<span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>
 
&nbsp;
 
{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
| &nbsp;
| &nbsp;
| &nbsp;
|}
</div>
= Sources =
 
----
 
#[https://www.nbcnews.com/nightly-news/video/portland-tackles-opioid-epidemic-with-community-paramedics-1227745347553 [3]]
#[http://narronline.org/wp-content/uploads/2013/09/NARR-White-Paper-111006-final.pdf [4]]
#Oxford House, Inc. Annual Report, Fiscal Year 2017<br/> [http://www.oxfordhouse.org/userfiles/file/doc/ar2017.pdf [5]]
#[http://www.oxfordhouse.org/userfiles/file/doc/ar2017.pdf [6]]
#[https://www.nbcnews.com/nightly-news/video/portland-tackles-opioid-epidemic-with-community-paramedics-1227745347553 [7]]
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div>
[[Category:SAFE-Treatment and Recovery]] [[Category:Housing Resources]]

Latest revision as of 12:36, 17 September 2024

Introductory Paragraph

Recovery housing is a highly individualized choice based on a variety of needs. For those seeking recovery housing, finding safe, affordable, and supportive housing options can be difficult. There are many types of housing in different settings and different levels of care. Supportive housing for people in recovery can range from peer-run homes to licensed treatment programs. It is important for individuals and communities to ensure recovery housing options are reputable and have the best interests of their residents in mind.

Key Information

SAMHSA defines recovery housing as "safe, healthy, family-like substance-free living environments that support individuals in recovery from addiction. While recovery residences vary widely in structure, all are centered on peer support and a connection to services that promote long-term recovery. Substance-free does not prohibit prescribed medications taken as directed by a licensed prescriber.” [1]

There are a variety of types of recovery home certifications and credentials:

  • The National Alliance for Recovery Residences (NARR) is a 501(c)3 nonprofit organization dedicated to expanding the availability of well-operated, ethical, and supportive recovery housing. NARR offers recovery homes with a suite of options for certification. [2]
  • The Commission on Accreditation of Rehabilitation Facilities (CARF) is an independent, non-profit accreditor providing accreditation services worldwide at the request of health and human service providers. CARF accreditation demonstrates a provider's commitment to enhance its performance, manage its risk, and distinguish its service delivery. [3]
  • Oxford Houses are self-run and publicly supported. A 501(c)3 corporation serves as an umbrella organization connecting networked Oxford Houses. It also allocates resources to duplicate their model. [4]
  • Independently-Owned and Operated Homes Recovery homes may also be independently owned and operated as a small business outside of an existing credentialing network - offering flexibility and ease of admission. These homes are often peer-led, allowing the residents to provide mutual support to one another and become financially self-sufficient. Although independently-owned recovery houses do not provide on-site licensed professional services, they often have resources and relationships with local recovery support professionals. Even though independently owned recovery homes do not hold a license or formal certification, they conform to local zoning and building safety codes for residential occupancy.

Note: States may have independent certification or credentialing requirements. Please check the recovery residence certification guidelines within your own state for more information.

Relevant Research

The National Council for Behavioral Health documents research findings which detail the benefits recovery housing has provided to individuals in obtaining and maintaining long-term recovery. These include: [5]

  • Reduced risk of relapse/recurrence
  • Lower rates of incarceration and recidivism
  • Higher income
  • Increased employment
  • Improved family relationships
  • Overall higher recovery capital

“Understanding Challenges for Recovery Homes during COVID-19.” This article addresses the different ways that recovery homes altered their model and structure as a result of COVID-19. Recovery homes use a social model approach to recovery that contrasts with mitigation procedures such as social distancing and stay-at-home orders. [6] Individuals residing in recovery housing are at a higher risk of contracting COVID-19 due to the group living environment. NARR has adopted the CDC guidelines and has applied them to recovery home settings. Recovery houses other than those with NARR certification that are licensed through the state also follow strict health and safety guidelines. Recovery homes that are independently licensed have less oversight.

Impactful Federal, State, and Local Policies

The 2018 SUPPORT Act (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment). In an effort to improve and expand recovery housing, Congress directed SAMSHA to collaborate with stakeholders and to facilitate the development of best practices for operating recovery housing. These best practices may include model laws that seek to prevent relapse and overdose (including greater access to MAT), as well as the development of indicators that could be used to identify fraudulent recovery housing operators. [7]

The National Council for Behavioral Health developed a set of policy recommendations for nationwide adoption and implementation of recovery housing. These can be found in the toolkit titled “Building Recovery State Policy Guide for Supporting Recovery Housing.” [8] In this guide, Alan Johnson, Florida Chief Assistant to the State Attorney, stated “We recommend that states be given the ability to require certification under NARR (National Alliance for Recovery Residences) or similar standards, or other recognized programs such as Oxford House™ to protect the vulnerable residents living in sober homes.”

SAFE Project maintains a list of current legislation on recovery housing by state. For more information please contact us at Community@safeproject.us.

Available Tools and Resource

  • SAMHSA provides a guide titled "Best Practices for Recovery Housing." [9]
  • SAFE Project has a web page dedicated to recovery housing. [10] It includes two downloadable resources. "A Community Case for Recovery Housing" addresses why communities should invest in recovery housing and covers seven concrete ways to support recovery housing. The "Choosing High-Quality Recovery Housing Workbook" provides information for individuals to make informed decisions on what recovery residence is best for them.
  • NARR hosts an annual summit on recovery housing, and its website offers a variety of resources and services. [11]
  • NASTAD provides recommendations and considerations for planning and starting a supportive housing program. [12]

Promising Practices

  • Oregon. Central City Concern (CCC) is a nonprofit that has worked in Portland since 1979. [13] It is a national model for integrating services which relieve homelessness, deliver substance use treatment and recovery options, provide jobs, and promote health. At its inception, CCC was charged with funding local recovery and treatment providers and preserving Old Town’s housing stock. They bought and renovated the Butte Hotel and other historic buildings and currently manage over 30 affordable housing units in Portland. One of these is the Richard L. Harris Building (also known as the “8×8”) a 12-story alcohol- and drug-free community building located above CCC’s Old Town Clinic. A news clip titled "What First Responders in Portland, Oregon, Are Doing" highlights the way the Portland community at-large is working with CCC in its efforts to offer peer support, employment training and assistance, and an extended safe place for people to build their foundation of recovery. [14]

Sources

  1. ↑ https://www.samhsa.gov/resource/ebp/recovery-housing-best-practices-suggested-guidelines.
  2. ↑ https://narronline.org
  3. ↑ http://www.carf.org
  4. ↑ https://oxfordhouse.org
  5. ↑ https://narronline.org/wp-content/uploads/2017/09/Recovery-Housing-Issue-Brief_May-2017.pdf
  6. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566762/
  7. ↑ https://www.samhsa.gov/sites/default/files/housing-best-practices-100819.pdf
  8. ↑ https://www.thenationalcouncil.org/wp-content/uploads/2018/05/18_Recovery-Housing-Toolkit_5.3.2018.pdf?daf=375ateTbd56
  9. ↑ https://store.samhsa.gov/sites/default/files/pep23-10-00-002.pdf
  10. ↑ https://www.safeproject.us/community/recovery-housing/
  11. ↑ https://narronline.org/annual-summit/
  12. ↑ https://nastad.org/sites/default/files/2023-10/Resource-PDF-Housing-Program-Recommendations-and-Considerations-102323.pdf?utm_source=newsletter&utm_medium=email&utm_content=Thinking%20About%20Starting%20a%20Supportive%20Housing%20Program%3F%20Recommendations%20and%20Considerations%20for%20the%20Planning%20Process&utm_campaign=UA-179397308-1
  13. ↑ https://centralcityconcern.org/
  14. ↑ https://www.nbcnews.com/nightly-news/video/portland-tackles-opioid-epidemic-with-community-paramedics-1227745347553
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