What You Need to Know…
Often I am asked ‘where can I find a good halfway house?’ That can be a difficult question to answer these days. 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 have some stigma to it – 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.
The good news is 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, www.narronline.org) . What was once known as ‘halfway’ , ‘¾ house’, ‘transitional house’ or ‘sober living’ now falls under the heading of Recovery Residence. Recovery residence is a broad term that encompasses the full range of recovery housing and possible service/program offered in the homes – from the democratically operated (often referred to as a ‘sober’ home) to the clinically oriented ‘extended care’.
NARR has emerged as the unifying entity long needed in a field that lacked professionalization and standards for residential programs. NARR introduced nomenclature to more precisely identify and define what a particular residence does and offers, as well as a standard and certification process implemented by individual state affiliates. NARR defines Recovery Residence as a “sober, safe, and healthy living environment that promotes recovery from alcohol and other drug use and associated problems.” A good recovery residence provides a community based environment to initiate and sustain recovery – defined as abstinence from alcohol and other non-prescribed drug use, and improvement in one’s physical, mental, spiritual, and social wellbeing.
Through NARR, Recovery Residences are now categorized under different Levels based on the type as well as the intensity and duration of support that they offer. Residential services provided span from peer based community models (found in all recovery residences) to medical and counseling services in recovery residences offering higher levels of support. The Levels titles and descriptions are designed to be simple, descriptive and intuitive. Higher residential levels describe higher levels of service and structure. Delineating recovery residence levels allows the consumer to identify and match the service need to the appropriate level of residence.
The residential Levels are:
Level 1: Peer Run
Level 1 recovery residences offer supportive housing in a community based peer environment. These recovery residences are commonly known as ‘sober homes’, and are most often found in single family residences. Oversight of residents is peer based within the home; residents are self-monitoring and accountable to each other. The primary criterion for this living environment is a willingness to be abstinent of mood altering substances. Self-help (i.e. 12 step) meetings and outside recovery support services are encouraged or required. Weekly house meetings are a standard component of this level, where chores and overall house functioning is processed within the community. While there is no paid staff at this level of support, there is often an overseeing operator who facilitates admissions and discharges to the home, and is available if there are house issues that cannot be resolved internally. There are no in-house services offered at this level, except the benefit of living in a supportive community.
Level 1 Peer-run facilities are best utilized by the individual who has physically and psychologically stabilized for a period of time from substance use, and would benefit from a sober environment that enables them to implement personal recovery in a safe community. They are appropriate for a more mature individual who has established adult living skills, is able to self-regulate, and is committed to recovery.
This level of support is desirable in that it tends to be cost contained. Length of stay varies and is open- ended – generally from 90 days to several years.
Level 2: Monitored
Level 2 residences are characterized by a community based environment supervised by a senior resident, house manager, or staff member. This staff member monitors operations and residents, and enforces structure that is implemented in the form of house rules or standards. There is an emphasis on community and accountability that manifests in a culture of peer support.
The living environment can be any type of dwelling, but most commonly is a single family residence with shared bedrooms. Like level 1, this setting often proves to be quite cost effective; length of stay varies and is open-ended.
At Level 2 some degree of programming is offered through in a weekly schedule, and there may be collaboration with outside service providers such as outpatient programs. Support groups and community meetings may be offered in-house. The approach for the Level 2 residence can best be summarized as a community-based model. This Level is appropriate for the individual with some intrinsic motivation who would benefit from a less intesive level of structure and support. The model is desirable in that it allows for an increased ability to access services over a longer period of time due to the affordability of the service models.
Level 3: Supervised
Level 3 residences are noted for their practical, life-skill oriented approach. They provide an increased level of structure and oversight, and often collaborate with an outside treatment component of some kind, i.e. outpatient services. Level 3’s offer life skill support and structure in- house or in cooperation with other service providers. Guidance is provided for the development of life skill and recovery sustaining activities, I.e. employment, self-help, physical health, etc. Case management and clinical services may be accessed in the outside community.
The residence itself can be quite varied – from an individual dwelling, to apartments or town homes, or perhaps a large dorm-like structure.
This Level is appropriate for the individual who would benefit from a higher degree of structure and support, perhaps after a period of stabilization at a clinical facility.
Level 4: Service Provider
This type of recovery residence provides peer based services plus life skills, and clinical programming. It is most often aligned or attached with a licensed treatment provider, and overseen by an appropriately credentialed and qualified management team. This level is characterized by a high degree of daily structure. Licensed and credentialed staff members provide in-house program services, and the facility itself is a licensed entity.
The residential facility is typically part of the continuum of care for an overseeing rehab institution. All types of residences and occupancy numbers can be found at this level, depending on the program. Average stays vary from several weeks to several months, depending on the acuity of the individual. Emphasis is placed on equipping the individual for the next phase of recovery, be that another residential level, or independent living.
Fees and demographics associated with this residential level vary considerably. Insurance benefits may be accessed at this type of residence.
This is an appropriate Level for the individual that needs a high degree of structure and support – someone new to the recovery process and/or needing life skill development.
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’ vs. ‘halfway houses’ are more likely to aspire to professionally accepted protocol of operation and adhere to certified standards.
Beth Fisher Sanders, LCSW, LCAS, MAC, CCS, MATS