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Recovery Residence Operations and Administration Back to Course Index

RR11

RECOVERY RESIDENCE OPERATIONS
AND ADMINISTRATION

 

Research continues to document the important role of social factors in recovery outcomes.  Not surprising, the best outcomes were predicted by alcohol-specific social support that discouraged drinking and/or drug use.

A critically important aspect of one’s social network is their living environment. Recognition of the importance of one’s living environment led to a proliferation of inpatient and residential treatment programs during the 1960’s and 70’s. The idea was to remove clients from destructive RR4living environments that encouraged substance use and create new social support systems in treatment. Some programs created halfway houses where clients could reside after they completed residential treatment or while they attended outpatient treatment. A variety of studies showed that halfway houses improved treatment.  Others created programs of longer stays to provide for long term support.

Up sprang various settings for recovery living and treatment levels.  These included, but are limited to Sober Living Homes, Residential Treatment, Social Models, and Communal Living.  They each had something slightly different to offer:

Sober Living Homes and or Half Way Houses:  Sober living homes are group homes for people who are recovering from addition issues.  People who live in sober homes have to follow certain rules and contribute to the home by doing chores. Most importantly, residents must stay sober throughout their stay in the home.

Residential Treatment:  Residential treatment is a live-in health care facility providing therapy for substance abuse, mental illness, or other behavioral problems.  These facilities offer a variety of structured programs designed to address the specific need of the participants.

Social Model:  Social model drug rehab programs emphasize the process of relearning responses to challenges, stresses and anxieties through ‘‘doing’’ and ‘‘experiencing’’ things in a new way by watching positive role models.  Alcoholics Anonymous is a successful example of social model recovery.

Communal Living:  Communal living offers a longer term approach to community based support.  Residents live in a supportive, substance clean environment for upwards of 12 months.  Many in this setting continue in some form of treatment throughout their stay.

Despite the advantages of these forms of treatment, there are limitations, as well.  First, many of these have been operating outside of a regulatory entity. This opens the door to subpar living arrangements, unethical providers, and community issues.

RR3Also, there is typically a limit on how long residents can stay in most of these settings. After some period of time, usually several months, residents are required to move out whether or not they feel ready for independent living. A second issue is financing the houses, which often includes government funding. This leaves facilities vulnerable to funding cuts. Finally, these living arrangements usually require residents to have completed or be involved in some type of formal treatment. For a variety of reasons some individuals may want to avoid formal treatment programs. Some may have had negative experiences in treatment and therefore seek out alternative paths to recovery. Others may have relapsed after treatment and therefore feel the need for increased support for abstinence. However, they may want to avoid the level of commitment involved in reentering a formal treatment program.  

With this disadvantages, over the years attention was drawn to the often poor, neglectful and sometimes unethical operations of these recovery practices within these residences.

Historically many of these settings were not required to be licensed, thereby no official standards of practice,ethics or compliance were enforced.  Treatment facilities had oversight, but not all recovery residences.  

Some common problems with recovery residences includes:

  • Anonymity is a cornerstone of groups like Alcoholics Anonymous, but it is impossible to enforce such a policy. The meetings are open to anyone, and not everyone attending will be willing to respect the anonymity of other members. 
  • Those who have been sent to a recovery group by a court mandate or family ultimatum may feel resentful about.  Often times such groups are only really effective when the individual chooses them.  
  • Some of the more experienced members of these groups can abuse their position.  
  • Some of these groups have been accused of promoting inaccurate information about addiction recovery.  
  • Residents being evicted with little or no notice.
  • Drug testing might be a necessary part of compliance monitoring.
  • Unscrupulous landlords
  • Lack of regulation and harm to neighborhoods
  • Whether state agencies have the resources to enforce regulations and adequately regulate these homes.
  • Land use problems, and nuisance issues caused by visitors at recovery residences, including issues with trash, noise, fights, petty crimes, substandard maintenance, and parking.
  • Lack of security at recovery residences and abuse of residents. The need for background checks.
  • The number of residents living in some recovery residences
  • Poor living conditions in some recovery residences.
  • Activities going on in recovery residences that require adherence to medical standards and that treatment services may be provided to clients in recovery residences. This included acupuncture and urine tests.
  • The allegation that medical providers capable of ordering medical tests, and billing insurance companies were doing so unlawfully.

The founding concept of these houses was to provide a safe, healing and supportive environment to those attempting to start their lives anew, to get a firm grasp on life without drugs and/or alcohol. These residences were meant to be run by those who operated with great understanding and empathy to the situation and challenges of the residents. House managers and/or house owners who understood the patience, guidance and support necessary to help these individuals succeed and move along the recovery path.  It is with this in mind that professional associations, state statutes and associations have gotten involved.

There are organizations that provide certification to recovery homes in some states. These organizations established standards of practice, ethics, quality assurance etc. which recovery residences must comply with in order to obtain and maintain accreditation. A few of these organizations are:

The Sober Living Network – Southern California

NARR – National Association of Recovery ResidencesRR10

GARR – Georgia Association of Recovery Residences

SCRRA – South County Residence Recovery Association (watchdog organization)

RROC – Recovery Residences of the Carolinas – membership includes following and maintaining standards and practices
set forth by RROC as well as membership in NARR.

GARR, SCRRA and RROC (and others throughout the country) established their mission statements and standards in accordance with NARR.

At the beginning of 2013 Florida’s Department of Children & Families was directed to submit a report detailing the findings about recovery residences in the state of Florida. They found that frequently, as noted above, recovery residences are not treatment providers and instead offer housing services only.  They also found that because the residences were largely unregulated there was no way to accurately estimate the number of recovery residences.  Their report also sited numerous legal issues due to state statutes, the federal Fair Housing Act and the Americans With Disabilities Act.  They reported community concerns regarding an increase in crime, impact on the housing market in neighborhoods where these residences were located and the lack of government oversight.

To answer these and other concerns, a House bill has been passed in multiple states and just recently in Florida to establish a certification for Recovery Residences that have met certain standards, ethics and practices. Moving forward Recovery Residences will no longer be affiliated with Sober Living, Halfway House etc. Recovery Residences that receive certification will set themselves apart from other recovery-oriented residences.

A certified recovery residence  will provide a safe, supportive and structured living environment and is designed for individuals that have completed an inpatient alcohol and drug treatment program or are attending an outpatient treatment program. Intensive support during early recovery, and continuing support for an extended period of time greatly increase the likelihood that participants will sustain their recovery.

Community is one of the primary benefits of a recovery residence. Other residents and counselors provide a constant source of support that simply isn’t available in any other non-rehabilitation setting.

Structure is another benefit that clients can find when they choose a recovery residence over returning to a non-structured living environment with roommates or family members.

Accountability for choices, including avoiding relapse and maintaining the expectations of residents in the home, is also a benefit to people in early recovery who otherwise might feel rudderless and lose their way. According to Chris Becker, vice president of operations at Sober Escorts, Inc. – “Recovery residences play a vital role in easing a recovering person’s transition from a primary treatment setting back into the real world. They can also serve as a safe place for a recovering person to lay their head while they attend PHP or IOP levels of treatment.”

RR2The process of establishing and monitoring minimum standards is an evolving one, intended to elevate the quality of recovery housing available to people in recovery. The National Association of Recovery Residences (NARR) is the guiding affiliation leading the way toward the creation of one single national standard of implementation and practice for recovery residences across the United States.

Recovery residences provide a vital service for initiating and sustaining long-term recovery and many thousands exist in the United States encompassing all levels of residential support.

However, a unified national voice for recovery residences did not exist nor was there a uniform standard for recovery residences. The National Association of Recovery Residences (NARR) fills these voids. Industry leaders from across the United States came together in 2010 and created a Standard that is the cornerstone of the national association. NARR is comprised of regional recovery residence associations representing all areas of the United States. Affiliation with a national association enhances professional legitimacy and strengthens advocacy. Most importantly, the NARR Standard assures those we serve that they have a safe community residence that promotes recovery.

The following identifies the operational and administrative job tasks that CRRA administrators must conduct to ensure continued compliance with rules, regulations, and the foundational philosophy of recovery residences. Certified Recovery Residence Administrators use professional knowledge and skills to determine when and how to conduct job tasks. The primary goal of this list of tasks is to assure that the Recovery Residence Administrator performs the administrative and operational duties necessary to run an effective and compliant Recovery Residence.

  1. Ensure compliance with applicable and non-discriminatory federal and state laws, to include: 
    1. Legal business entity
    2. Current liability coverage/insurance appropriate to the level of recovery offered
    3. Written permission from the property owner of record to operate a recovery residence on the property
    4. Compliance with criminal background screening for staff
    5. Resident compliance with legal obligations 
  2. Implement and maintain resident financial policies that address sound accounting principles for documenting all resident financial transactions, including: a. Resident fiscal records, to include fees, payments, deposits, and refunds. b. Record retention policies. c. Prohibition of financial relationships between staff and residents, except in regard to disclosed residence fees and/or formal work
  3. Implement and maintain a records retention policy and procedure to ensure the residence maintains accurate and complete records of all resident charges, payments, deposits and refunds.
  4. Implement and maintain policies and procedures to ensure a separation between the employment of a resident by a recovery residence provider or staff and the employee’s continued residence in the recovery home. Work agreements must be written and ensure that the resident agrees to work on a voluntary basis, the resident is paid a fair wage, consistent with the marketplace; and the resident’s performance on the job does not impact his or her recovery and continued residence in the home
  5. Collect resident demographic information 
  6. Anticipate and respond appropriately to emergent issues, including employee issues, changes in rules and regulations, industry trends, and crisis/disaster
  7. Participate in residence monitoring, review and/or audit actions by regulatory agencies

National Alliance of Recovery Residences (NARR) 

Residence Operational and Quality Assurance Standards

Purpose of Standards: To ensure integrity of program services and quality and environment of care for recovery residences offering supportive services to addicts and alcoholics in need. The treatment and recovery communities recognizes that recovery takes time and that residential support RR1has many facets. From residential treatment models to long-term recovery homes, the addiction and mental health community affirms the necessity of a continuum of care to adequately address the total needs of the addicted community.

NARR established a standardized the spectrum of recovery oriented housing and services in 2011. The standard was developed through a strength-based and collaborative approach that solicited input from all major regional and national recovery housing organizations. Guidance for the standard was also received from recovery residence providers from across the nation representing all 4 levels of support and nationally recognized recovery support stakeholders.

As per NARR – “The standard defines the minimum elements people in recovery should require from their housing providers. The standard provides a road map for developing the full spectrum of recovery housing to better match needs and a blue print for housing providers to Orise to the occasion. The standard empowers recovery housing choices with regards to placement and resource allocation.”

This course will take you through all of the standards giving you examples of a compliance model.

NARR’s first major initiative was developing a uniform national standard for recovery residences. The Standard is applicable to all recovery residences regardless of the form of home organization or level of support services offered. It is rigorous with respect to health, safety, professionalism, training and ethics.

NARR fills a void in existing recovery residence practices and accountability. The initiatives that are the organization’s immediate focus include the programs below. Each is described briefly in this section:

  1. Building the organization’s administration,
  2. Maintaining a standard for recovery residence quality improvement,
  3. Affiliating with regional/local recovery associations and residences,
  4. Advocating for the adoption of the NARR Standard nationally,
  5. Delivering technical assistance to form regional recovery residence associations,
  6. Serving as a recovery residence information and referral clearinghouse,
  7. Promoting research, evidence-based training and public information campaigns, and
  8. Defending the housing rights of recovery residences and

The Standard and associated work incorporates a uniform terminology that has been missing from discussions about recovery residences and the work they do.

In addition to health and safety considerations, the NARR Standard:

Emphasizes the dignity of the individual and the power of peer-to-peer recovery principles

Recognizes that different requirements are appropriate for different levels of recovery support. Four levels of recovery residences are defined which span the range from peer-operated homes to residences that provide a wide variety of professional treatment and other recovery support services.

Fosters implementation of evidence-based practices for diverse populations of providers and residents.

The creation of a rigorous and widely accepted Standard for recovery residences is important for several reasons.

The Standard:

  1. Creates a process for identifying best practices and codifies them with clear terminology for recovery residence participants (residents), housing providers and associations; legislative and regulatory bodies; medical and behavioral health professionals; criminal justice personnel and other stakeholders,
  2. Provides a common basis for assessing the quality and effectiveness of recovery residences,
  3. Responds to many requests by Federal and state agencies for a single, coherent and uniformly implemented set of criteria for recovery residences,
  4. Defines a uniform terminology for all recovery residence types which has been a source of misunderstanding and confusion due to a lack of precision and differing regional meanings. This common language creates a precise framework for communications about critical issues.
  1. Addresses legitimate local concerns about operational practices of recovery residences operating in their communities,
  2. Poises the recovery residence and field as a key participant in the comprehensive health care reform service delivery

Currently NARR has developed a certification program for recovery residences. Each state affiliate of NARR has the responsibility and duty to provide that certification program to owners of recovery residences within their state.

Levels of Support and their Standard Criteria

The following are the NARR Standards for Recovery Residences. Not all of these standards apply to each of the four levels of residences.

 

RECOVERY RESIDENCE LEVELS OF SUPPORT

 

 

 

 

 

 

 

 

 

 

 

 

S

T

A

N

D

A

R

D

S

 

 

C

R

I

T

E

R

I

A

 

LEVEL I

Peer-Run

LEVEL II

Monitored

LEVEL III

Supervised

LEVEL IV

Service Provider

 

 

 

Organizational

 

 

 

 

hierarchy

Overseen organizational

 

 

 

ADMINISTRATION

 

Democratically Manual or P&P

House manager or senior resident

Policy and Procedures

Administrative oversight for service providers

Policy and Procedures

hierarchy

Clinical and administrative supervision

Policy and Procedures

 

 

 

Licensing varies from state to state

Licensing varies from state to state

 

 

House rules provide

Life skill development

Clinical services and

 

Drug Screening House meetings

Self-help meetings

structure

Peer run groups Drug Screening

emphasis

Clinical services

utilized in outside community

programming are provided in house

Life skill development

SERVICES

encouraged

House meetings

Involvement in self-

Service hours provided in house

 

 

 

help and/or

 

 

 

 

treatment services

 

 

 

 

Primarily single family

 

All types – often a step

 

Generally single family residences

residences

Possibly apartments or other dwelling

Varies – all types of residential settings

down phase within case continuum of treatment center

RESIDENCES

 

types

 

May be a more

institutional in

 

 

 

 

environment

 

No paid positions

At least 1

 

 

 

within the residence

compensated position

Facility manager

Credentialed staff

STAFF

Perhaps an overseeing officer

 

Certified staff or case managers

 

 

You will learn in detail the breakdown of the levels of support in the course Residence Recovery Support.  2213

NARR Member Standards

  1. Organizational/Administrative Standards
    • Recovery Residences are legal business entities as evidenced by business licenses or incorporation documents;
    • Recovery Residences have a written mission and vision statement;
    • Recovery Residences have a written code of ethics;
    • Recovery Residences property owners/operators carry general liability insurance;
    • Recovery Residences comply with state and federal

If required, documents such as licenses and certificates of occupancy are visible for public view;

  • Recovery Residences clearly identify the responsible person(s) in charge of the Recovery Residence to all residents;
  • Recovery Residences clearly state the minimum qualifications, duties, and responsibilities of the responsible person(s) in a written job description and/or contract;
  • Recovery Residences provide drug and alcohol free environments;
  • Recovery Residences collect and report accurate process and outcome data for continuous quality improvement;
  • Recovery Residences have written permission from the owner of record to operate a Recovery Residence on their

2.     Fiscal Management Standards

  • Recovery Residences maintain an accounting system that fully documents all resident financial transactions such as fees, payments and

3.     Operations Standards

  • Recovery Residences post emergency procedures and staff phone number in conspicuous locations;
  • Recovery Residences post emergency numbers, protocols and evacuation maps

4.     Recovery Support Standards

  • Recovery Residences maintain a staffing plan;
  • Recovery Residences use an applicant screening process that helps maintain a safe and supportive environment for a specific group of persons in recovery;
  • Recovery Residences adhere to applicable confidentiality laws;
  • Recovery Residences keep resident records secure with access limited to authorized staff only;
  • Recovery Residences have a grievance policy and procedure for residents;
  • Recovery Residences create a safe, structured, and recovery supportive environment through written and enforced residents’ rights and requirements;
  • Recovery Residences have an orientation process that clearly communicates residents’ rights and requirements prior to them signing any agreements; collects demographic and emergency contact information and provides new residents with written instructions on emergency procedures and staff contact information;
  • Recovery Residences foster mutually supportive and recovery-oriented relationships between residents and/or staff through peer-based interactions, house meetings, community gatherings, recreational events, and/or other social activities;
  • Recovery Residences foster recovery-supportive, alcohol and drug-free environments through written and enforced policies and procedures that address: residents who return to alcohol and/or drug use; hazardous item searches; drug-screening and or toxicology protocols; and prescription and non-prescription medications usage and storage;
  • Recovery Residences encourage each resident to develop and participate in their own personalized recovery plan;
  • Recovery Residences inform residents on the wide range of local treatment and recovery support services available to them including: 12 step or other mutual support groups, recover community centers, recovery ministries, recovery-focused leisure activities and recovery advocacy opportunities;
  • Recovery Residences provide nonclinical, recovery support and related services;
  • Recovery Residences encourage residents to attend mutually supportive, self-help groups and/or outside professional services;
  • Recovery Residences provide access to scheduled and structured peer-based services such as didactic presentations;
  • In accordance with State Statute (397), when making referrals, Recovery Residence provide access to a minimum of three third party clinical service providers;
  • Recovery Residences offer life skills development services;
  • Recovery Residences offer clinical services in accordance to State laws

5.     Property Standards

  • Recovery Residences abide by all local building and fire safety codes;
  • Recovery Residences provide each residents with food and personal item storage;
  • Recovery Residences place functioning fire extinguishers in plain sight and/or in clearly marked locations;
  • Recovery Residences have functioning smoke detectors installed. If the residence has gas appliances, functioning carbon monoxide detectors are installed;
  • Recovery Residences provide a non-smoking internal living environment;
  • Recovery Residences have a community room large enough to accommodate house meetings and sleeping rooms that adhere to local and state square footage requirements;
  • Recovery Residences have one sink, toilet and shower per five residents or adhere to local and state requirements;
  • Recovery Residences have laundry services that are accessible to all residents;
  • Recovery Residences maintain the interior and exterior of the property in a functional, safe and clean manor that is compatible with the neighborhood;
  • Recovery Residences have meeting spaces that accommodate all residents;
  • Recovery Residences have appliances that are in working order and furniture that is in good condition;
  • Recovery Residences address routine and emergency repairs in a timely fashion

6.     Good Neighbor Standards

  • Recovery Residences provide neighbors with the responsible person(s) contact information upon request. The responsible person(s) responds to neighbor’s complaints, even if it is not possible to resolve the issue;
  • Recovery Residences have rules regarding noise, smoking, loitering and parking that are responsive to neighbor’s reasonable complaints;
  • Recovery Residences have and enforce parking courtesy rules where street parking is scarce.

 

FARR: Florida Association of Recovery Residences 

StandardsOverview–Takenfromhttp://farronline.org

The term Recovery Residence was promulgated by the National Alliance for Recovery Residences (NARR) and refers to standards-based recovery housing. As the Florida NARR affiliate, FARR certifies provider compliance with the NARR Standard. This Standard is constructed atop the Social Model of Recovery Philosophy (SMRP) which emerged in California some seventy years ago, attracted science-based, academic researchers over the following decades which, in turn, led to SMRP migration nationwide in the late 60’s and beyond.

Recovery-oriented housing founded on SMRP principles continues to be studied academically due to its proven effectiveness in promoting and sustaining long-term recovery.

What is the distinction between certification and licensing? Consider the differences between these word groupings: Mandatory, Licensing & Regulations -vs-Voluntary, Certification & Standards. Florida mandates all behavioral healthcare providers must be licensed. Some also seek accreditation. Due their clinical component, Level IV Recovery Residences are DCF licensable entities and often elect to seek accreditation from JCAHO and FARR as a Certified Recovery Residence. Commencing July 1, 2015, all Level I, II & III residences are required by state statute to seek, achieve and sustain certification in order to be eligible for referral from DCF licensed treatment providers.


Domains

Together, 37 individual standards containing 113 sub-standards are organized under four (4)

domains to form the NARR Standard. Developed through consensus and drawing

on vast experience accumulated by a broad spectrum of recovery housing providers, NARR Quality Standards for Recovery Residences provide for safe, alcohol & drug free, dignified, peer- supportive environments designed to promote consumer development of Recovery Capital.

The Substance Abuse and Mental Health Services Administration (SAMSHA) and the White House Office for National Drug Control Policy (ONDCP) recognize NARR as a national recovery- oriented housing authority.

 

Levels

Each level implements the social model of recovery philosophy (SMRP) to varying degrees and offers distinctly different service intensities. Level IV Residences are licensed providers who blend the “Medical Model” and “Social Model” to create a hybrid often referred to as

the “Florida Model”. Level III Residences offer life skills training and 24/7/365 supervision, generally by credentialed staff. Level II Residences monitor resident participation in individual and community recovery activities and Level I Residences, often viewed as a “pure”

reflection of SMRP, are democratically run homes where residents self-govern by a set of “house rules” and share monthly expenses.

The following are the core principles set forth by NARR for all certified recovery residences to follow and adhere to.

Core Principle: Operate with integrity

Are guided by a mission and vision: Applies to all levels of support

  1. A written mission statement that corresponds with NARR’s core principles as stated in this
  2. A vision statement that corresponds with NARR’s core principles as stated in this document

Adheres to legal and ethical codes: Applies to all levels of support

  1. An affidavit that attests to complying with non-discriminatory state and federal requirements.
  2. Marketing materials, claims and advertising that are honest and substantiated as opposed to:
  • False or misleading statements or unfounded claims or exaggerations Testimonials that do not really reflect the real opinion of the involved individual Price claims that are misleading
  • Therapeutic strategies for which licensure and/or counseling certifications are required but not applicable at the site
  • Misleading representation of outcomes.
  1. Prior to the initial acceptance of any funds, the operator must inform applicants of all fees and charges for which they will be, or could potentially be, responsible. This information needs to be in writing and signed by the
  2. The operator must maintain accurate and complete records of all resident charges, payments and deposits. A resident must be provided with a statement of his/her personal charge and payment history upon
  3. The operator must disclose refund policies to applicants in advance of acceptance into the home, and before accepting any applicant
  4. Staff must never become involved in residents’ personal financial affairs, including lending or borrowing money, or other transactions involving property or services, except that the operator may make agreements with residents with respect to payment of
  5. Policy and procedure that ensures refunds consistent with the terms of a resident agreement are provided within 10 business days, and preferably upon departure from the

Are financially honest and forthright: Applies to all levels of support

  1. Identifying the type of accounting system used and its capability to fully document all resident financial transaction, such as fees, payments and deposits
  2. Policy and procedure for disclosing to potential residents their financial obligations, including costs for which they might become liable, such as forfeiture of any deposits and fees as a result of prematurely leaving the home
  3. Policies about the timing of and requirements for the return of deposits, if financial deposits are required
  4. The ability to produce clear statements of a resident’s financial dealings with the operator (although it’s not a requirement that statements be automatically produced)
  5. Policies and procedures that ensure the follow conditions are met, if the residence provider or a staff member employs, contractors or enters into a paid work agreement with residents:

Paid work arrangements are completely voluntary. Residents do not suffer consequences for declining work. Residents who accept paid work are not treated more favorably than residents who do not.

Paid work for the operator or staff does not impair participating residents’ progress towards their recovery goals.

The paid work is treated the same as any other employment situation.  Wages are commensurate with marketplace value, and at least minimum wage. The arrangements are viewed by a majority of the residents as fair.

Paid work does not confer special privileges on residents doing the work. Work relationships do not negatively affect the recovery environment or morale of the home. Unsatisfactory work relationships are terminated without recriminations that can impair recovery.

Collect data for continuous quality improvement: Applies to all levels of support.

  1. Procedures that collect resident’s demographic information
  2. Procedures that collect, evaluate and report accurate process and outcomes data for continuous quality improvement

 

Operate with prudence: Applies to all levels of support

  1. Legal business entity documentation e.g. incorporation, LLC documents or business license
  2. Documentation that the owner/operator has current liability coverage and other insurance appropriate to their level of support
  3. Written permission from the owner of record to operate a recovery residence on the property
  4. Policies and procedures that ensure that background checks are conducted on all staff, including volunteers that have direct and regular interaction with

 

Core Principle: Uphold resident rights

Communicate rights and requirements before agreements are signed Applies to all levels of support

  1. A process that ensures residents receive an orientation on agreements, policies and procedures prior to committing to
  2. Written resident’s rights and requirements (e.g. House Rules and grievance process) posted in common areas
  3. Written resident agreement that includes: Services provided

Recovery plan including a move-in (i.e. goals and objectives) and move-out (i.e. contingency) plan

Financial terms

  1. Resident documents that fully disclose policies regarding possessions (personal property) left in a

Promote self and peer advocacy: Applies to all levels of support

  1. Grievance policy and procedures, including the right to take unresolved grievances to the operator’s oversight organization
  2. Policy and procedure for identifying the responsible person(s) in charge to all residents Support housing choice: Applies to all levels of support
  3. Applicant screening policies and procedures provide current residents a voice in the acceptance of new
  4. Policies and procedures that promote resident-driven length of stay
  5. Policies and procedures that defend residents’ fair housing rights

Protect privacy: Applies to all levels of support

  1. Policies and procedures that keep resident’s records secure, with access limited to authorized staff only
  2. Policies and procedures that comply with applicable confidentiality laws

 

Core Principle: Are recovery-oriented

View recovery as a person-driven, holistic and lifelong process: Applies to all levels of support

  1. Documenting that residents participate in the development of their recovery plan including an exit plan and/or lifelong
  2. Documenting that the operator cultivates alumni participation. Are culturally responsive and competent: Applies to all levels of support
  3. Policies and procedures that identify the priority population, which at a minimum includes persons in recovery from substance use but may also include other demographic
  4. A staffing or leadership plan that reflects the priority population’s
  5. Documented cultural responsiveness and competence trainings that are relevant to the priority population.

 

Core Principle: Are peer staffed and governed

Involve peers in governance in meaningful ways: Applies to all levels of support

  1. Some rules are made by the residents that the residents (not the staff) enforce
  2. A resident council or process is in place that ensures resident’s voices can be heard
  3. The resident council has a voice in the governance of the home

Use peer staff and leaders in meaningful ways: Applies to all levels of support

  1. Residents’ responsibilities increase with their length of stay or progress in their recovery.
  2. Staffing or leadership plan that formally includes a peer component
  3. Written job description and/or contracts for peer staff and leaders

Maintain resident and staff leadership based on recovery principles: Applies to all levels of support

  1. A home staffing or leadership plan that includes current residents and where possible, former residents that model recovery principles
  2. Leader and/or staff job descriptions and selections are based in part on modeling recovery principles

Create and sustain an atmosphere of recovery support: Applies to all levels of support

  1. Integrated recovery support in the daily activity schedule
  2. The schedule includes formal and informal opportunities for staff and resident interaction in support of recovery

Ensure staff are trained or credentialed appropriate to their level: Applies to all levels of support

  1. Written staffing or workforce development plan
  2. Certification and verification policies and procedures Provide supportive staff supervision: Applies to all levels of support
  3. Policies and procedures for supervision of staff
  4. Ongoing skills development, oversight and support policies and procedures appropriate to staff roles and level of

 

The Minimum Standards for Recovery Residences

Minimum requirements that any quality recovery residence must meet are based on the combined experience of hundreds of recovery residences and all other recovery living homes over decades of operation. These minimum requirements are compatible with a wide variety of home organizational models.

Pending the enactment of the new Florida House bill 21 for recovery residences and recovery residence administrators, the standards determined by a states designated entity, will apply to all recovery residences seeking certification through their recognized state affiliation. For example, in Florida, Florida Association of Recovery Residences (FARR) is the Florida state affiliate for NARR. The standards will be maintained, reviewed and monitored by the same designated state entity.

The following is taken from The Sober Living Network and used here as another example of a set of standards and policies established to support and maintain an ethical and recovery oriented system of care.

Standards

  1. Safety, maintenance, appearance, space requirements

A good home is safe, well maintained, has suitable space for its residents and is in keeping with neighborhood standards.

  1. Admission requirements, forms, documentation, record keeping and reporting Recovery Residences are families of people in recovery, living together for mutual support. Appropriate admission guidelines ensure that residents are compatible, and that they are united by a desire to further their recovery from addiction. The application and admission process supports full disclosure to potential residents about their rights and obligations, and establishes a mutual understanding of the recovery goals of the home.
  2. Abstinence, enforcement, testing

The heart of the sober living experience is the process of learning how to live a life free from drugs and alcohol. Requirements in this section support the important aspects of enforcing abstinence and of managing relapse situations. Other requirements ensure that toxicology screening is conducted in a consistent and fair manner by competent and trained individuals.

  1. Resident rights to quiet enjoyment of home and premises

Residents are a family, and entitled to the peaceful enjoyment of their home and property. Homes serving both men and women must meet additional requirements to ensure the privacy and safety of their residents. Resident rights to utilize common areas must be consistent with the family nature of the household.

The following is a list of some (not all) of the policies, procedures and practices that an ethical, effective and safe recovery residence will need to adopt and comply with. These policies and procedures should be available for review to potential residents.

Recovery Residence Policies & Procedures

  1. Health & Safety Standards
  2. Administration and Financial Requirements
  3. American Disability Act (ADA) Standards
  4. Available Support Services:
    1. Vocational services
    2. Peer support
    3. Skills training
    4. Community resource referrals
  5. Residence Staffing
  6. Residence Insurance:
    1. General liability insurance
    2. Professional liability insurance
    3. Residence Vehicle insurance
    4. Fire insurance
  7. Written Compliance regarding the following:
    1. Local zoning ordinances
    2. Local business license requirements
    3. Local building codes
    4. Local fire safety regulations
    5. Local health codes
    6. Local approval from the appropriate government agency for new program services or increased client capacity
  1. Building and Grounds:
    1. The recovery residence shall ensure that the appearance, safety and cleanliness of the building and grounds are
  2. Physical Facility:
    1. Bedrooms
    2. Bathrooms
    3. Shared living space
    4. Kitchen
    5. Staff accommodations
    6. Laundry service
    7. Front & Backyard
  3. Food Services
    1. Meal preparation
    2. Menu planning
    3. Special dietary needs
    4. Sanitation
    5. Safety
  4. Medical Standards
    1. Medical screening
    2. Tuberculosis questionnaire
    3. Written policy and procedure on safe medication storage and disposal
    4. Medication management
  5. Risk Management
  6. Infection Control
  7. Residents Policies
    1. Resident Contracting
    2. Drug & Alcohol testing policies
    3. Residence Rules
    4. Client Rights
    5. Fees/Rent
  8. Emergency Procedures
    1. Medical and Psychiatric Emergency procedures & policies
    2. Weather Contingencies/Severe weather plan of action
  9. Landlord/Tenant guidelines
  10. Local coalition membership

 

Grievance Policy and Process – Florida Association of Recovery Residences

rr12It is important for all recovery residences to have a clearly stated and defined grievance policy and process. These policies and processes need to be easily accessed by all residents.

The following are the grievance policies and procedures as determined by NARR and listed on the FARR website. Farronling.org

Grievance Policy

It is the policy of The Florida Association of Recovery Residences (FARR) to ensure Certified Residences and stakeholders grievances are handled respectfully, appropriately, and professionally.

The Formal Grievance Procedure should be used to resolve interpersonal conflict between individuals and to report issues with existing FARR policy that a Certified Residence believes should be examined prior to the next scheduled annual policy review meeting.

The Formal Grievance Procedure should not be used for retribution or personal/agency gain.

The Formal Grievance Procedure includes but is not limited to the investigation, validation, and recommendation of the Ethics Committee as to the standing of the Certified Residence and sanctions and/or disqualification of their certification to the FARR Board, when necessary.

What Makes a Recovery Residence?

Let’s Go Back to Where We started

This course began defining and delineating a recovery residence from other types of “sober” living environments. Hopefully you have learned not only the differences but the benefits a recovery residence offers compared to other “sober” homes.

As discussed earlier, the term ‘halfway house’ has come to mean different things in different parts of the country – for instance in Pennsylvania, a halfway house is a structured residential treatment center, whereas in Florida it might be a transitional residence following treatment. Additionally, the term halfway house tends to be associated with some stigma – there has been much in the news about ill reputed operations and overdoses at halfway houses. The language used to describe the residential milieu is misleading, confusing, and can have negative connotations.

As evidenced by this certification and the passing of House Bill 21, the industry has evolved to become far more professional and intentional in its language, primarily through the efforts of the National Alliance for Recovery Residences (NARR). What was once known as a halfway house, three-quarter house, transitional house or sober living home now falls under the heading of recovery residence.

Defining Recovery Residence in short: Recovery residence is a broad term that encompasses the full range of recovery housing and services and programs offered in the homes – from the democratically operated to clinically oriented extended care.

Why the Recovery Residence Name Matters

The delineation of a recovery residence continuum model offers an unprecedented degree of professionalism to a portion of the field of addictions recovery that has heretofore been laden with stigma. Those that refer to themselves as recovery residences, rather than halfway houses, are more likely to aspire to professionally accepted protocol of operation, and ideally adhere to certified standards.

 

FAQ SHEET – Solutions for Treatment Expansion Project (STEP) – A Project of Future Associates, Inc.

Fair housing laws, zoning and land use regulations and how they impact residential alcohol and drug treatment programs and sober living residences.

FREQUENTLY ASKED QUESTIONS (FAQ) • August 2008

Q 1. What is federal fair housing law?

  1. Individuals in this country have the right to choose where they live. Therefore, fair housing issues have historically fallen under civil rights law. In fact, the formal name of the Fair Housing Act is Title VIII of the 1968 Civil Rights Act. It was the first major civil rights law that focused specifically on housing since the first Civil Rights Act passed in 1866 as part of Reconstruction legislation following the Civil War

The fair housing portion of the 1968 legislation prohibited housing discrimination based on color, national origin, and religion, and in 1974, added gender. Many types of housing related discrimination are covered under this act, such as mortgage lending, homeowner’s insurance, and sales. This discussion, however, shall focus on those tenets of the law as they impact zoning and other land use considerations.

Further refinements to fair housing laws were made in the Fair Housing Amendments Act (FHAA) of 1988. In the late 1970s and early 1980s community resistance escalated against the establishment of residential treatment and other housing for substance abusers and the mentally ill. The tipping point for this social phenomenon was the new practice of deinstitutionalization of those populations who were previously treated and/or housed in large state funded and administered institutional facilities. The thinking of the day, still current, is that the mentally ill and substance abusers have better treatment outcomes and living experiences in smaller “family-like” homes and residences located in residential neighborhoods where they can be a part of the community, rather than in large impersonal institutions removed from the pulse of community life.

Q 2. What parts of the Fair Housing Amendments Act (FHAA) of 1988 directly impact the siting of residential alcohol and drug treatment programs?

 

  1. There are six key elements of the law that affect residential treatment programs and sober living.
    1. Specific populations are designated as “handicapped” or “disabled” and are therefore protected from housing discrimination. Included in this classification are substance abusers and the mentally ill. (Note: The exception to the classification of housing protections for substance abusers is for those that are currently active in their addictions to illegal
    2. Residential treatment programs and other types of group homes—where individuals reside for an ex- tended period as opposed to an over- night or “hotel” situation—are housing situations protected by the
    3. The law establishes that local governments have an “affirmative duty” to provide “reasonable accommodation,” or flexibility, when making decisions about zoning and land use regarding housing for persons with dis- abilities. (See Q 4 for further description.)
    4. Persons with disabilities, or their agents, have remedy within the law and can sue if they believe that they have been discriminated
    5. Any local regulations specifically designed to restrict residential alcohol and drug treatment programs or sober living residences that are not generally applicable to other comparable housing are also in violation of fair housing
    6. A local government that uses community resistance as a basis for its decision to deny a conditional use permit (CUP) to a residential program for persons with disabilities is in violation of those

Repeatedly, the courts have ruled that local governments denying CUPs based on stereotypical negative projections are discriminatory in that their effect is to restrict where persons with disabilities can live. Furthermore, courts have stated that such negative projections have no validity as they are not supported by data and in fact, are contradicted by data. Making a determination as to whether a group home or residential treatment program is a threat to neighborhood health and safety must be made on an individualized basis using specific criteria applied only to the residence under consideration and not be made on stereotypical assumptions.

Q 3. If it has been a violation of fair housing laws since 1988 for a local government to base denial of a CUP for a residential alcohol and drug treatment program on community resistance to such pro- grams, why does it remain today the most effective means communities have to prevent their local governments from issuing CUPs to these programs?

  1. It is commonly known in local governments that fair housing laws make it illegal to discriminate in housing sales, rentals or lending practices on the basis of race, national origin, religion or gender. What is not as commonly known is how fair housing laws also apply to zoning and land use decisions regarding residential treatment programs that house persons with disabilities such as sub- stance abusers. However, lack of knowledge by local governments is not an excuse for discrimination. The FHAA has been in existence since 1988 and has been widely publicized by the U.S. Department of Housing and Urban Development and by national and local dis- ability and fair housing advocacy organizations.

One reason for this lack of attention is because residential programs for substance abusers and the mentally ill comprise a small percentage of the housing and building concerns that come before local governments. For instance, in San Diego County, compare the number of houses, apartment complexes and commercial buildings to that of only 77 licensed residential alcohol and drug treatment programs. In fact, some local governments have never had occasion to consider a CUP for such a program. Of the 19 local governments in San Diego County, only nine have a state licensed residential substance abuse program.

Q 4. Since zoning and land use issues depend upon local conditions, do local regulations auto- matically pre-empt fair housing laws?

  1. No. Fair housing laws prohibit local governments from using zoning and other land use requirements to discriminate against the housing needs of persons with disabilities. Courts have further strengthened the intention of federal fair housing laws in a series of decisions that apply any one of three tests to local regulations: (1) discriminatory intent, (2) discriminatory impact, or (3) failure to provide reasonable accommodation.6 An ac- commodation is considered reasonable as long as it does not place an undue administrative or financial burden on the local government. Former California Attorney General Bill Lockyer, put it this way:

“Thus, municipalities relying upon these alternative procedures have found themselves in the position of having refused to approve a project as a result of consideration which, while sufficient to justify the refusal under the criteria applicable to grant of a variance or conditional use permit, were insufficient to justify the denial when judged in light of the fair housing laws’ reasonable accommodation mandate.”

Not all denials of CUPs are discriminatory against per- sons with disabilities. Sometimes it may be both legitimate and appropriate for a local government to turn down a residential alcohol and drug treatment provider for a use permit. That is why the application of reasonable accommodation criteria is critical. Reasonable accommodation is not a one way street. Providers are also obliged to be flexible in their responses to legitimate land use concerns that their facility might cause, such as increased parking, traffic, building size or design, or outdoor lighting.

There is good litmus test to apply as to whether or not a zoning or land use regulation or practice is discriminatory. It can be considered discriminatory if it focuses on persons with disabilities—in other words focuses on “WHO” is being served by the residence, not “WHAT” type of residence it is.

 

Q 5. How can residential alcohol and drug treatment providers ensure that they can get a CUP?

  1. There are no guarantees that treatment providers will be granted a CUP, but fair housing laws definitely improve the odds for providers over what they have been in the past. When a residential provider submits a CUP application it is important to include a request for reason- able accommodation. Specifically it should include:
    • Identifying the category of persons with disabilities per fair housing law (substance abusers) that the proposed residential program will be
    • Specifying the accommodations in zoning land use that will be necessary to make this residential facility available to those with
    • Identifying the ways in which the requested accommodation will not impose an undue financial or administrative burden on the local government to which the provider is

However, a provider proposing a treatment program in a facility no larger than other residences in the neighborhood, or a treatment pro- gram with six beds or fewer seeking a small increase its number of beds, may not need to apply for a CUP, but instead can apply for reasonable accommodation. There are many reasons to pursue this course of action. Any provider seeking to do this may want to consult with a fair housing professional who is knowledgeable in this area of land use.

Q 6. Can local governments put special restrictions on sober living residences?

  1. No. Sober living residences are housing where people abstinent from alcohol and drugs seek a clean and sober living environment. There are no treatment or counseling services given, although they may hire a house manager. They are considered the same as any other residential rental. Local governments cannot re- quire restrictions or permits for one residence without requiring the same for all. They exist by right, just as any single family dwelling unit, whether it is a single family home, a unit in a duplex, a large apartment complex, or other types of dwelling units.

Single family dwellings are regulated under one of two different categories: “Occupancy limits” and “definition of family.” “Occupancy” regulations limit the number of people allowed per square footage and is considered non- discriminatory because the standards apply equally to everyone and are, therefore, generally exempt from the application of fair housing laws. However, few local governments use this type of density limitation as it can impact large families.

The most commonly used regulation is how a local jurisdiction defines “family.” In California no local government may limit the number of adults who choose to live together. This is due to a 1980 case, City of Santa Barbara v. Adamson, in which the California Supreme Court, based on California privacy laws, ruled that people that want to live together have the right to do so.

Therefore, no California local government can restrict the number of unrelated adults choosing to live together. Many local governments still have a restrictive definition of family that limits the number of unrelated people that can live together, but such regulations are not in compliance with the law.

Q 7. If my state’s fair housing laws are not equivalent to the protections specified in federal fair housing law, which one prevails?

  1. Federal fair housing law will always be considered the “floor.” If state law provides fewer protections than federal law, then federal law pre- vails. Some states may have more protections in their fair housing laws than federal law, such as California. In that case, the law that provides the most protection prevails.

 

Q 8. What are the consequences for local governments that do not follow fair housing laws in zoning and land use decisions for residential alcohol and drug treatment programs?

A local government can be sued by a provider or potential residents of a residential facility if it is perceived that local government decision makers intentionally discriminated against them, or the effect of their acts was discriminatory, or they failed to provide reasonable accommodation. Similarly, the United States Department of Justice has authority to step in and enforce federal law when there is an allegation violation of the FHAA in a local government’s zoning or land use decisions. If the courts find in favor of the residential provider or its potential residents, a local government would have to pay attorney fees.

Additionally both federal and state fair housing laws provide for the added potential consequences of having to pay damages and be assessed penalties.

It should be noted that an actionable act by a local government in zoning and land use decisions against persons with disabilities can only be committed at the final step of the decision making process by elected officials who are the ones legally responsible for those decisions.

KEY PROVISIONS OF THE FEDERAL FAIR HOUSING AMENDMENTS ACT OF 1988

Sec. 802. [42 U.S.C. 3602] Definitions

  • “Handicap” means, with respect to a person–
    • a physical or mental impairment which substantially limits one or more of such person’s major life activities,
    • a record of having such an impairment, or
    • being regarded as having such an impairment, but such term does not include current, illegal use of or addiction to a controlled substance (as defined in section 102 of the Controlled Substances Act (21 U.S.C. 802)).

Sec. 804. [42 U.S.C. 3604] Discrimination in sale or rental of housing and other prohibited practices

As made applicable by section 803 of this title and except as exempted by sections 803(b) and 807 of this title, it shall be unlawful–

 

  • (2)To discriminate against any person in the conditions, or privileges of sale or rental of a dwelling, or in the provision of services or facilities in connection with such dwelling, because of a handicap of–
    • that person; or
    • a person residing in or intending to reside in that dwelling after it is so sold, rented, or made available; or
    • any person associated with that

(3) For purposes of this subsection, discrimination include:

(B) a refusal to make reasonable accommodations in rules, policies, practices, or services, when such accommodations may be necessary to afford such person equal opportunity to use and enjoy a dwelling.

 

References

  1. Federal Fair Housing Act, 42 U.S.C. Section 3602 (h)
  2. Federal Fair Housing Act, 42 U.S.C. Section 3602 (h) (3)
  3. Federal Fair Housing Act, 42 U.S.C. Section 3604 (f) (3) (B)
  4. Federal Fair Housing Act, 42 U.S.C. Section 3613 ( c )
  5. Daniel Lauber, “Impacts on the Surrounding Neighborhood of Group Homes for Persons with Developmental Disabilities.” Governor’s Planning Council on Development Disabilities, Springfield, Illinois, Sept.
  6. Council of Planning Librarians, “There Goes the . . A Summary of Studies Addressing the Most Often Expressed Fears about the Effects of Group Homes on Neighborhoods in which They Are Placed,” April 1990.
  7. Ted H. Gathe, City of Vancouver, WA, “Group Homes: Local Control and Regulation Versus Federal and State Fair Housing Laws,” Municipal Research and Services Center of
  8. Bill Lockyer, California Attorney General, Letter to All California Mayors, “Adoption of a Reasonable Accommodation Procedures,” page 3, paragraph 2, May 15,
  9. Federal Fair Housing Act, 42 U.S.C. Section 3615
  10. Recovery Residence Administrator Role Delineation Study Formal Report February Florida Certification Board. February 29, 2016.
  11. NARR – National-Recovery-Residence-Quality-Standards-Oct-7-2015
  12. org. National Alliance of Recovery Residences. 2014
  13. org. Florida Association of Recovery Residences.
  14. Utah Administrative Rule R501-18. Recovery Residence Services. Utah Department of Administrative Services. Division of Administrative Rules. June 1, 2015.
  15. Standard for Quality Sober Living The Sober Living Network. March 30, 2012.
  16. Standards for Recovery Recovery Residences of the Carolinas. Rroconline.org. 2013.
  17. Fair Housing FAQ www.FuturesAssociates.org. A Project of Futures Associates. August 2008.
  18. Recovery-Oriented Systems of Care (ROSC) Resource White Paper Report. SAMSHA. September 2010.
  19. Strategic Initiative #4 Recovery Leading Change: A Plan for SAMHSA’s Roles and Actions. SAMSHA. 2011
  20. Howell, Where recovery residences and addiction treatment meet. Addiction Professional. November 27, 2013.