There are a vast number of sober living homes, extended care, ‘halfway houses’ and transitional living programs that are currently operating, and new ones open up each day. How do you know which programs are providing quality services?
The following questions can help identify organizations that are operating at a professional level and following industry standards.
- What level of structure and support is offered in a given day?
All homes fall under the apt descriptor recovery residence. Services and structure offered in these settings can vary considerably. The National Alliance for Recovery Residences (NARR) has standardized levels of homes based on the type, intensity and duration of support they offer. (see my Pro Talk article) The higher a recovery residence’s NARR level, the more structure, services and support tends to be offered. i.e. educational groups, life skills and counseling, support groups, accountability and monitoring, etc. It should be noted that the NARR model states that one level is not ‘better’ than another, only that delineating service levels of recovery residences allows for a better match of need with appropriate residence.
Understanding a residence’s policy on allowable medication is also critical. Quality recovery residences have clear policies on medication, its use and storage in the residence.-Beth Sanders
Structure is most often found in the rules and expectations of a recovery residence. It is always a good idea to see a copy of resident rules / standards prior to making a choice. Issues such as accountability for whereabouts, curfew, 12 Step meeting attendance requirements, passes away from the residence, telephone privileges, expectations for employment / education, family / friend contact and fraternization all provide important information regarding the amount of structure provided by a residence. Residences at the higher levels may have expectations regarding utilization of outpatient or IOP treatment. Additionally, most residences have a minimum time commitment for length of stay. It is important to understand the interventions or consequences that will occur if house rules are broken. Understanding a residence’s policy on allowable medication is also critical. Quality recovery residences have clear policies on medication, its use and storage in the residence.
- What setting and services does the recovery residence provide?
Each recovery residence varies in the type of residence it provides. Some are located in houses, some are in apartment complexes, and others are in refurbished motels. Ask specific questions about the actual residence. What type of building is it? Where is it located? Who maintains the residence? Are meals provided, community based or independent? How many people are there in a bedroom? How many share a bath?
Each recovery residence also varies in the type of support services it provides to residents. It is a good idea to ask for a specific list of support services provided i.e. life skill groups, peer counseling or coaching services, employment / education assistance, transportation provisions, recreational activities, and referral or linkage to clinical and community resources. While the majority of recovery residences do not provide treatment, many do provide helpful support services to facilitate individual and community recovery. Ask to see a resident calendar, which will list groups, fellowship activities, etc.
- What services do fees cover?
Are fees reimbursable if there is a relapse or dismissal...?-Beth Sanders
Generally, the higher the service level, the higher the fee. Inversely, the lower the NARR recovery residence level, the lesser amount of services offered. It is also typical that the greater number of people in a bedroom and residence, the lower the fee. Other important questions include: How are fees paid? Are fees reimbursable if there is a relapse or dismissal for any reason? Are residents expected to contribute toward their own fees through work efforts? Are there ancillary fees such as drug screens or recreational activities? Is food a separate cost?
- Can you describe your staff and staffing patterns?
Many staff members at recovery residences are in recovery themselves, and operate with a strong peer based focus where shared experience and goals are the uniting and motivating force. Degrees and certifications of recovery residence staff can be indicators of a higher degree of structure and support within the residence. Professionally trained and educated staff are equipped to assess and triage presenting situations and needs of residents within the organization – particularly helpful for the newly recovering individual.
Staff ratios are an important consideration when evaluating acuity of the potential resident. The lower the staff to resident ratio, the more attention and care each resident should receive.-Beth Sanders
Staff ratios are an important consideration when evaluating acuity of the potential resident. The lower the staff to resident ratio, the more attention and care each resident should receive. This type of residence can be quite beneficial for the newly recovering individual, and/or those who are younger in age, and would fit NARR’s definition of a Level 3 or 4 facility. On the other hand, individuals with more time away from alcohol and drugs, as well as having some maturity in age and motivation may be more appropriate for programs with a lower supervision and higher staff to resident ratio (NARR Level 1 and 2).
- What is your drug screening policy?
Drug screening is the primary way recovery residences verify sobriety of their residents. Methods vary from breathalyzers and urinalysis cup testing to laboratory confirmed screening. Drug screening frequency and protocol should be ethical, and appropriately match the level of recovery residence service and structure. Important questions include: What drugs are being tested for? How often is drug testing conducted? Are drug tests random and witnessed? Is there a separate fee for drug testing? Frequency and sophistication of testing is directly correlated to the level of recovery residence, i.e. the lower the recovery residence support and structure level, the lower the drug testing frequency and refinement.
- What is the procedure if a resident relapses?
Relapse is not an uncommon occurrence in the recovery process, and quality recovery residences have ethical protocols to manage relapse within their residence.-Beth Sanders
It is very important to understand how a recovery residence addresses relapse. Industry standards typically dictate a zero tolerance policy for alcohol and drug use. A recovery residence cannot be safe for recovering individuals if it allows residents who are actively using drugs or alcohol to live onsite. Relapse is not an uncommon occurrence in the recovery process, and quality recovery residences have ethical protocols to manage relapse within their residence. While a resident is typically removed from the living environment, they should always be directed to a safe place, to include a higher level of care where possible. Ideally, emergency contact information secured during the admission process is utilized for input. Referrals are provided for other treatment and residential resources, or the resident is transferred to another location within the program, if the recovery residence is large enough to accommodate this.
Often there is a ‘cooling off’ period where the resident must be out of the residence for a minimum period before being considered for readmission. Readmission opportunities should be limited, however, in order to prevent chronic relapse patterns within the residence.
It can be challenging to navigate the myriad of recovery residences that exist. The questions listed above address basic expectations for operations at any level of the recovery residence spectrum. Touring a residence, even talking with those already living there, is the very best way to get a sense of the residence, staff and community. Time invested in research of a facility, as well as matching a residence appropriately to need can minimize the risk for problematic issues later in the recovery process.
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