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Raising the bar for recovery residences
Recovery residences today suffer a similar dilemma faced a generation ago in professional counseling. Anyone with a house or a room to rent can hang a shingle and call themselves “recovery housing,” “sober living,” “halfway house,” “three-quarter way housing,” “transition housing,” or various other names. The name variations are as diverse as the services provided, from a nightly place to eat, sleep and attend a mutual-help meeting to multiple-year intensive treatment programs provided by licensed professionals.
The critical question is, “How do consumers, recovery professionals and other organizations know if a facility provides alcohol or other drug users and people with mental health needs with a safe, healthy environment for recovery?” A common challenge in the addiction treatment field is “what's next?” for patients stabilized at primary treatment centers who have low recovery capital, are at high risk for relapse, and whose recovery was not sustained during previous outpatient treatment.
As a vital component of today's recovery care continuum, recovery residences can be an affordable and effective option as managed care creates shorter treatment stays. Professionally operated, recovery-oriented residential programs that enmesh residents in appropriate services in the local recovery community fill the service gap in a way that is not only economical, but also highly conducive to sustainable recovery.
The Georgia Association of Recovery Residences (GARR) is joining other leading voices in calling for high-quality services across the emerging recovery-oriented systems of care continuum for individuals and their recovery allies. GARR is a unique 501(c)3 organization that serves as a professional, volunteer accrediting body for recovery residence organizations in Georgia. Our members encompass varied demographics, for-profit and non-profit providers, and a range of service levels-from long-term treatment to what traditionally has been called a “sober home.” Operationally, we are a diverse group of organizations large and small. Our commonality is a shared commitment to professional standards of operation and recovery services supported by accountability to our local communities and to one another.
History and evolution
GARR was founded in 1987 in Atlanta by seven demographically diverse recovery residences that came together for the purpose of support, accountability and idea sharing. Doug Brush, Past President of GARR and Men's Director of the Metro Atlanta Recovery Residences, says GARR's history “began as support meetings, particularly around issues of interfacing with the people and communities in which our facilities were located. Soon we established standards that would enhance the recovery programs of our organizations, and developed written criteria for recovery residence operations. We then created a peer review system and opened our organization for membership.
Over time, GARR's monthly meetings have evolved to include offering CEU trainings as an additional benefit to our members, as well as the professional community. Though the organization has grown tremendously, the founding principals of idea sharing, peer support, professional accountability, and most importantly quality operational standards remain essential to the GARR mission.”
Under the leadership of Joel Bagley, Immediate Past President of GARR and Executive Director of Purple, Inc., membership has grown to 53 organizations at varying levels of care, serving approximately 2,000 men and women in Georgia. This represents 17 percent of total residential recovery services provided in our state.
GARR's Executive Committee meets monthly for action planning, and membership meetings occur bimonthly for information sharing, fellowship and CEU trainings. Staff from member facilities volunteer for a variety of roles. Those who complete accreditation training conduct site visits with existing and prospective members.
The accreditation and re-accreditation process is a time of training and mentoring. Often newcomers have a passion for helping others but are unaware of the need for such essentials as a written policy and procedure manual, a business license, or even an understanding of local zoning requirements. The accreditation process helps the newcomer define “who we want to be” along the continuum from residential treatment to supportive living.
If treatment groups and counseling services are offered in a residence, the new organization is also guided toward obtaining the necessary state licensure to provide these services.
Guiding principles
Five cornerstone principles guide GARR's work:
Promoting professionalism and quality standards for recovery residences.
GARR standards are extensive and address the core areas of operations, facilities, and services provided. Reviewers are longtime recovery residence operators. Each prospective member is reviewed carefully and brought to committee for final approval. Organizations that do not evidence professional operating practices or a minimum of recovery support services and programming are not granted accreditation.
All GARR members demonstrate professionalism through their record keeping, staffing and safety protocol (i.e., drug screening, emergency procedures). Each residential program must provide evidence of written policy and procedures that meet the GARR standards, as well as appropriate staffing (such as adequate resident-to-staff ratios, adequate qualifications for specific positions, etc.). Clear, ethical financial protocols must also be evidenced.
All member facilities provide some type of programming to support and develop resident recovery skills. Treatment programs offer a varying number of clinical counseling hours each week, while extended care programs offer life skills classes.
Members are professionally accountable.
Re-accreditation site visits occur every two years to ensure that the organizations are following GARR standards. Also, the GARR Ethics Committee reviews and resolves written concerns or complaints regarding a member residence. Barbara Sickmon, the Ethics Committee Chair throughout GARR's history, continues to resolve ethics complaints through collaborative action plans that typically do not result in sanctions.
Members value GARR accreditation as it becomes more widely recognized as a stamp of quality in the state of Georgia; if there are issues cited, most facilities will take quick corrective action in order to maintain their status.
Our collective membership is a source of support, idea sharing and mentoring for each other and prospective members.
GARR's bimonthly membership meetings are well attended. The spirit of non-competitive camaraderie recognizes each program's niche-and acknowledges that need far exceeds capacity. New members are welcomed and helped in addressing the inevitable challenges they will face. Invariably, mentoring begins with more experienced programs, a parallel process to working the program of recovery that we espouse.
Continuing education trainings provided for a nominal fee at each GARR membership meeting provide opportunities to develop skills, maintain individual credentials and expand networks with the professional community.
Active collaboration with all levels of care in the professional community
GARR members recognize that there is a “continuum of care” and that successful programs assist their residents in moving fluidly through it. We partner with primary treatment centers, the legal system, mental health providers, vocational and employment resources, and the 12-Step community to assist our residents in developing living skills to sustain ongoing recovery. GARR member meetings provide a forum for sharing these resources-everything from alcohol and drug testing to liability insurance.
Additionally, GARR collaborates with other professional organizations to sponsor an annual Recovery Networking Fair and conference each September during Recovery Month.
Partnering with community resources to promote alcohol and other drug recovery
Every year, GARR along with other professional recovery organizations in Georgia, including the Georgia Council on Substance Abuse (GCSA), host a Recovery Awareness day at the state Capitol. This year official proclamations supporting alcohol and other drug recovery were read in each chamber of the legislature, where the galleys were packed with people in recovery and their allies who wore “Recovery Happens!” T-shirts. Neil Kaltenecker, GARR's Secretary and the Executive Director of the GCSA, organized recovery advocacy training that delivered a consistent message to many legislators who received personal testimonies from people carrying a message of “Replace Stigma with Recovery Resources.”
GARR is also an active partner with the State Board of Pardons and Paroles and the Department of Corrections. Recovery residence services provide an important alternative to incarceration, and GARR members fulfill an equally vital role in successful community reentry. George Braucht, GARR Executive Committee member and Program Specialist with the Georgia Parole Board, describes GARR's role in harnessing “the emergent power of wellness and recovery from alcohol and drug use and criminal behavior. This most often develops through long-term, albeit sometimes intermittent, involvement in indigenous social support systems and activities.” He adds, “I expect that empirical research will show that these recovery services produced unprecedented improvements in personal health and community safety early in the 21st century.”
Occasionally a local government will attempt to impose housing restrictions that unknowingly violate the Americans With Disabilities Act (ADA) and fair housing statues. J. Scott Maddox, GARR's Legislative and Community Affairs Committee Chair and Executive Director of Alpha Recovery, assists the local member in responding by providing thorough documentation of the relevant federal statutes along with recent case law. GARR works with local governments to ensure that the rights of people in recovery are recognized while promoting community safety and health.
Elevating the field
GARR is developing a database of service outcomes that will assist in establishing the efficacy of recovery residences. What is found to be effective is spread throughout member organizations via the GARR standards, which are periodically reviewed and updated.
On the basis of this experience, GARR is beginning an important national dialogue on standardizing operations and terminology pertinent to residential levels of care. We seek to define universal levels of care for recovery residences (preferred term) while dispensing with the archaic, nebulous and stigma-laden terms “halfway” and “three-quarter way” house.
GARR members are beginning discussions with thought leaders utilizing language from the American Society of Addiction Medicine (ASAM) Patient Placement Criteria manual. Rather than reinvent the wheel, we can hone ASAM-PPC terminology to better apply to freestanding recovery residences. In particular, PPC levels III (clinically managed residential) and II (less intensive service provision) require finer granularity to better apply to residential service providers.
There are many advantages to using the ASAM criteria, but most important for the patient will be a vastly improved fluidity and collaboration along the continuum of care. By utilizing a universally understood language and level of care, the patient can be effectively placed at the level of care appropriate to clinical needs. More will be forthcoming in the professional literature about this, and your thoughts and input are welcome in these discussions.
Finally, perhaps the recovery field is in need of a cohesive national association for recovery residences. Oxford Houses have been around since 1975 as a model for peer-owned and -operated recovery residences. The Connecticut Community for Addiction Recovery has an unprecedented Internet presence for locating “recovery housing.” CARF accredits a variety of recovery residence programs. GARR, a member of the National Association of Addiction Treatment Providers (NAATP), is unique as a statewide, peer-to-peer accrediting body for recovery residences. A national association involving all of these organizations could increase our professional legitimacy and the strength of our advocacy. In today's changing healthcare market, creating a nationally accepted nomenclature and corresponding standards for recovery residences is paramount to our survival.
I invite you to join in the developing discussions regarding recovery residences. Working together we can ensure that appropriate, professional care and sufficient funding are readily available for the individuals and communities we serve.
Beth Fisher, LCSW, MAC, CCS, is President of the Georgia Association of Recovery Residences (https://www.garronline.org). She also is the Founder and Executive Director of Hope Homes, Inc., an extended care recovery residence in Atlanta. Her e-mail address is beth.fisher@hopehomesrecovery.org.
