Recovery Residences: Four Distinct Support Levels

By John Lehman

FARR does not offer a rating scale that measures the efficacy or valuation of any individual Certified Residence. Our mission is to ensure the availability of housing that is:

1. safe and dignified
2. alcohol and drug free
3. a peer supportive environment
4. a good neighbor and responsible citizen

FARR Standards and the FARR Code of Ethics serve as guides for how best to achieve these four goals and provide a basis for service provider accountability to an independent, non-profit organization dedicated to upholding the resident’s right to access high quality, recovery-oriented housing. Some support levels are more organically ‘peer-supportive’ than others and, when selecting a program, individual residents are ‘best’ served by first gaining a deeper appreciation of defining criteria for each level.

FARR recognizes four distinct support levels under the singular term Recovery Residence. One level is not better or more advanced than the others, but instead offers a unique service structure most appropriate for a particular resident. By way of example, Level 1 residences are perhaps best exemplified by the Oxford House model. This non-profit 501c (3) program operates nationwide, supports over 1,200 recovery homes that serve more than 24,000 residents annually. Highly regarded by clinicians, peer specialists and SAMHSA alike, the Oxford House program is documented by evidenced based studies demonstrating consistently positive outcomes. Many people achieve sustainable recovery while residing in Level 1 residences. Visit www.oxfordhouse.org to learn more about this program.

During the first year of my recovery, I resided in a residence that excelled at the aforementioned core goals. The apartment I occupied was safe and modestly appointed, clean and adequate to my needs. I could rely on management to screen anyone whom they, or we residents, suspected was using and to immediately and responsibly remove active users from our community. All my housemates were in recovery and once weekly we convened as a community for a 12 step meeting on property. We were expected to attend meetings throughout the remainder of the week, work with our 12 step sponsor and take full ownership of our recovery program. This is a basic description of a FARR Level 2 residence. The Social Model might have been embraced more thoroughly to further empower that particular community. However; an argument is just as easily made that the maintenance and development of future resident leadership is primarily the responsibility of the residents themselves.

Management was attentive to neighbor concerns regarding parking, noise and general resident behavior. Having established good relations, residents took pride in caring for the upkeep of the property. It was one of the nicest homes on the block, complete with the proverbial white picket fence. The home supported eleven residents in four attached units. While that community, like so many others, experienced the typical ebb and flow of casual, short timers who were uncommitted, I personally know of at least six housemates who remain clean and sober today. By my unscientific, outcome measurement, this rates a batting average above .500, which in this world, is a ‘hall of fame’ performance by most standards. Thousands of Floridians achieve long-term recovery while residing in Level 2 residences every year.

Level 1 & 2 residences require residents adhere to a published set of house rules and consequences, however; it is generally Level 3 residences who offer 24/365 supervision, often by credentialed staff, such as behavioral techs, recovery coaches and/or peer specialists to ensure resident accountability. By design, Level 3 recovery residences are vested in delivery of only peer-support services. No clinical (medical) services are performed directly within or by a FARR Certified Level 3 residence. These services often includes life skill mentoring, assistance with crafting an individual resident’s recovery plan, communal meal preparation and dining, group transportation to self-help meetings and access to recovery coaches. This support is generally more appropriate for residents who require a structured environment during early recovery from addiction. Conversely; it is most likely inappropriate for a resident who has already achieved a solid footing and demonstrates a personal commitment to their recovery. Residents of a Level 3 residence often independently elect to participate in external clinical services such as attending an outpatient groups of their choice and/or engaging a private therapist for one-on-one counseling. “Independently elect” is a very important distinction. Many factors, including some that meet licensing thresholds, influence the distinction between a Level 3 and
Level 4 recovery residence.

Level 4 residences incorporate the Medical Model (licensable clinical services) into the Social Model to varying degrees. In Florida, by virtue of state statute 65.397, Level 4 residences are required to obtain and maintain appropriate licensure from the Department  of Children & Family Services – Substance Abuse (DCF).

“Florida Model” programs are defined as Partial Hospitalization Programs (PHP) with day/night community housing. In DCF licensing parlance, these are generally Residential 3 service providers. In turn, these programs fall under the FARR definition of a Level 4 residence. DCF Residential 4 & 5 programs also meet FARR Level 4 criteria. Each of these classifications offer varying degrees of clinical service, provided by credentialed staff, along with a recovery-oriented housing component. At first glance, the DCF licensing requirement coupled with FARR Certification may appear redundant. Nothing could be farther from the truth.

DCF is our state licensing authority. The Department is tasked with determining the successful completion of application documentation as it is submitted by substance abuse disorder treatment programs throughout the state. DCF does not have the funding, staff, infrastructure or appetite to measure service provider compliance to Standards established to promote high quality, recovery-oriented housing. This is not a job function the Department considers to be their their mandate nor is the Department prepared to take on this job at this time. Their report to the Florida Senate Appropriations Committee published October 2013 made this fact absolutely clear. To download a copy of this study, visit http://www.dcf.state.fl.us/programs/samh/docs/SoberHomesPR/DCFProvisoRpt-SoberHomes.pdf

As the Florida Affiliate of the National Alliance of Recovery Residences (NARR), FARR offers Level 4 Recovery Residences the opportunity to voluntarily submit for certification to our Standards and Code of Ethics. This opportunity directly addresses issues of import to the entire continuum of care. Persons seeking long-term, residential care and transitional support for themselves or a family member gain free, reliable access to a published list of programs who have voluntarily sought and secured certification. This voluntary approach appears to be provide a constructive and much needed path to establishing a mechanism for accountability without running afoul of FHAA and ADA protections. The current NIMBY climate that attempts to utilize municipal zoning as an alternative path amounts to an irresponsible waste of tax payer dollars, further dividing communities at a time when there is an ever-increasing need to foster local resources that effectively address what has now risen to the level of “An American Epidemic”.

FARR does not measure or evaluate the quality of clinical care. This is outside of our mission and expertise. Instead, FARR measures accountability to standards designed to ensure the delivery of those four core goals referenced at the onset of this publication. Peer Support, provided through varying degrees of Social Model implementation within the residential component of a Level 4 residence is the guiding consideration. To learn more regarding the Social Model and how this structure is best embedded in recovery housing, please visit http://narronline.org/wp-content/uploads/2014/09/Maximizing-Social-Model-Principlesin-Residential-Recovery-Settings.pdf

The entire continuum of care recognizes an important truth: that the Acute Care model of “28 days treatment” followed by a graduation celebration and the abrupt return of the graduate to the same environment from which they originated has proven far less effective than has the long-term, transitional approach that gradually “steps the client up” towards assuming responsibility for their own chronic disease management. When framed positively, many refer to this achievement as ‘Recovery’. FARR Certified Residences receive our seal of approval.

The FARR certification process is rigorous and subsequent grievances related to non compliance are taken very seriously. Our raison d’etre is to ensure residents have access to quality, peer-supportive, recovery oriented housing to assist them along their journey to secure lasting freedom from the bondage of addiction.