Bringing Recovery Housing to Scale in Ohio: Lessons Learned.

OBJECTIVE: States across the country are recognizing recovery housing, an abstinence-based living environment promoting recovery from alcohol and other drugs, as an important yet underrepresented choice within their housing and treatment continuums. However, strategies for bringing recovery housing to scale are not well known. Building upon broader quality improvement efforts in Ohio, this paper aims to identify barriers and facilitators to expanding recovery housing in Ohio by understanding the perspectives of relevant stakeholders. METHODS: We conducted 6 recovery housing program site visits; 24 semi-structured key informant interviews with state and national researchers, policy makers, and stakeholder groups; and 16 focus groups with administrators and staff, residents, and local stakeholders including housing developers, advocates, and county and city policy makers (n = 113). Focus groups were disaggregated by stakeholder membership and guided by separate interview protocols. Transcripts were coded and analyzed to identify primary themes. RESULTS: Most participants across stakeholder groups expressed a need to increase recovery housing supports within the state. Two facilitators and three barriers emerged as primary themes from the qualitative analysis. Facilitators included (1) the ability of recovery housing programs to identify, connect, and collaborate with other recovery housing programs and service systems, an approach that increased a program's ability to refer, accept new clients, learn about programmatic and financial supports, and advocate for a space within the services continuum, and (2) support from legislators and other local stakeholders to include recovery housing as a viable and necessary option. Barriers included (1) variations in recovery housing definitions, language, and understanding that limited recovery housing providers' ability to connect with one another and be eligible for different streams of support, (2) availability of funds and ability to access them, and (3) restrictions in federal, state, and local regulations and codes. CONCLUSIONS: Although recovery housing is limited and has not been integrated into many housing and treatment continuums, there is growing consensus about its importance for various subpopulations. Developing consistent definitions, program models, funding streams, networks of recovery housing providers, and collaborations among recovery-oriented systems of care will reduce misperceptions and enhance the likelihood that recovery housing will be expanded.

The Role of Recovery Housing: Prioritizing Choice in Homeless Services.

Housing options for people exiting homelessness and seeking recovery from substance use disorders are limited. Policies tend to favor low-demand models such as housing first and permanent supportive housing that do not require abstinence, but offer immediate housing placement based on consumer choice and separate housing from clinical services. While these models have proven effective in promoting housing retention, especially among individuals with a primary diagnosis of mental illness, evidence to support positive outcomes related to people with a primary or co-occurring substance use disorder are mixed. Recovery housing models provide abstinence-focused environments and integrated peer support embedded within a recovery framework. Various models exist along a continuum from fully peer-run to clinically staffed residences. However, this continuum is typically separate from the homeless services system, and many barriers to integration persist. Recent national dialogues have begun to explore opportunities to integrate housing and substance use recovery approaches to meet the needs of people who need both types of support. This perspective paper argues that recovery housing is essential for supporting some homeless individuals and families. Within a comprehensive continuum based on choice, both recovery housing and low-demand models can support housing retention, reduce homelessness, promote recovery, and foster self-determination.

A framework for integrating young peers in recovery into adolescent substance use prevention and early intervention.

Substance use among adolescents is associated with a range of negative outcomes and risk-taking behaviors. Identifying and intervening early is essential to reducing associated risks in adolescence and adulthood. New approaches are needed to equip youth-serving systems with tools to identify and respond to substance use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) has emerged as a promising public health framework and there is a growing research interest in effective adaptations for its use with adolescents. However, healthcare settings, schools, and other community-based settings are slow to adapt SBIRT, citing gaps in knowledge and capacity to deliver evidence-based substance use prevention and early intervention. Further, these settings and the surrounding communities often lack the treatment and other prevention and recovery support resources needed for youth who screen as high-risk. Integrating young adult peers with personal lived experience of substance use recovery may meet this practical need. By drawing upon their shared experiences and skills developed in recovery, young adult peers can provide developmentally appropriate screening and intervention support to youth - while also providing urgently needed skills and time to under resourced settings. This article describes the value of young adult peer roles in expanding youth substance use prevention and early intervention, and features Project Amp as an example. Project Amp was designed as an extended, four-session brief intervention for low to moderate risk adolescents, delivered by trained young adult peers. Project Amp draws on best practices from peer recovery support and prevention and early intervention approaches such as SBIRT.