- I- Halfway house definition:
Is an institution that allows people with physical, mental, and emotional disabilities, or those with criminal backgrounds, to learn (or relearn) the necessary skills to re-integrate into society and better support and care for themselves.
As well as serving as a residence, halfway houses provide social, medical, psychiatric, educational, and other similar services. They are termed "halfway houses" due to their being halfway between completely independent living on the one hand, and in-patient or correctional facilities on the other hand where residents are highly restricted in their behavior and freedoms.
It aimed to recreate a home with its amenities and to allow the participants to get to know one another and coexist within the neighborhood, for example, by running errands, praying at mosque and going for walks.
A halfway house, “dry house” or “sober house” is defined as a more accessible transition between hospitalization and life in the community. Its objective is to promote a social support system for alcohol and substance dependents who will benefit from the supportive treatment structure in such a sober environment.
“Alcohol and Drug Halfway House Treatment Facility” means a transitional residential program providing services to service recipients with alcohol and/or drug abuse or dependency disorders with the primary purpose of establishing vocational stability and counseling focused on re-entering the community. Service recipients are expected to be able to self-administer medication and to work, seek work, or attend vocational/educational activities away from the residence for part of the day. Services include counseling contacts, lectures, seminars, and other services necessary to meet the service recipient’s assessed needs.
II- Theoretical basis of halfway house in substance use disorder intervention:
1. Philosophy of the community-based approach
The core goal of the community-based treatment model is to ensure a holistic approach to the treatment and care of drug users; the intensity of essential care varies according to the nature and complexity of the problems experienced by the individual.
The key principles of community-based treatment are:
• continuum of care from outreach, basic support and reducing the harm from drug use to social reintegration, with no “wrong door” for entry into the system;
• delivery of services in the community – as close as possible to where drug users live;
• minimal disruption of social links and employment;
• integrated into existing health and social services;
• involve and build on community resources, including families;
• participation of people who are affected by drug use and dependence, families and the wider community in service planning and delivery;
• comprehensive approach, taking into account different needs (health, family, education, employment and housing);
• close collaboration between civil society, law enforcement, and the health sector;
• provision of evidence-based interventions;
• informed and voluntary participation in treatment;
• respect for human rights and dignity, including confidentiality;
• Acceptance that relapses is part of the treatment process and will not stop an individual from re-accessing treatment services.
2- Service delivery model
The model provides for comprehensive care for people who are affected by drug use and dependence. Examples of these services include community support, primary health services, and expert medical and psychiatric diagnoses and services in district and referral hospitals or specialized clinics. Clients are referred to whichever community services are appropriate, based on a screening of drug and alcohol problems. This approach ensures community participation and linkages to ongoing drug-use prevention and other services, which aim to reduce the harm associated with drug use in the community.
3-Two conceptual theoretical models for halfway houses have been proposed: the family model and the social model.
Residence function is based on a typical familiar group inserted in a social organization. Further, families are systems that operate through transitional rules originating from repeated interactions
among individuals, while the social atmosphere proposes a therapeutic factor.
4- Sober Living Houses are alcohol and drug free living environments for individuals attempting to maintain abstinence from alcohol and drugs . They offer no formal treatment but either mandate or strongly encourage attendance at 12-step groups.
III- Implications for substance user-service organizations:
It is important to note that although the halfway house and therapeutic community approaches for substance dependence rehabilitation share similar concepts and philosophies, their treatment modalities differ.
The therapeutic residence model currently designated for psychoactive substance users seems to be a low-cost service option. Further, it offers dignity to the patients while building social support in a self-help network system, yielding broad changes in favor of living in sobriety.
Positive outcomes seem to be linked to respect for institutional traditions among resident members: for example, promotion of abstinence requirement (whether in or out of the residence) and the setting of residence permanence goals. To achieve such outcomes, it is necessary to guarantee continuity in the support process with reinforcement from governmental actions.
Services include:
• Drug screenings
• Support group meetings
• Counseling
• Life skill development
• Vocational training
• Financial courses
• Basic education classes
• Anger management therapy
• Driver’s license courses
• Computer skills training
• Employability training
• Grief counseling
• Mentoring services
• Self-esteem classes
• Individual counseling
• Group therapy
• Family therapy
IV - Initial policies and procedures for halfway house:
(1) The facility must maintain a written policy and procedure manual which includes the following:
(a) The intake and assessment process;
(b) A description of its aftercare service;
(c) A policy ensuring that employees and volunteers practice standard precautions as specified by the Centers for Disease Control (CDC) to prevent transmission of infections, HIV, and communicable diseases;
(d) Guidelines and techniques for volunteers and employees to monitor, control and report facility infections;
(e) A quality assurance procedure which assesses the quality of care at the facility. This procedure must ensure treatment has been delivered according to acceptable clinical practice;
(f) Drug testing procedures if used by the facility;
(g) Exclusion criteria for service recipients not appropriate for the facility’s services;
(h) Policy and procedures which address the methods for managing disruptive behavior. (restrictive procedures).
(i) A policy that identifies efforts to reduce the use of isolation and restraint;
(J) A policy and procedure that establishes when employment is appropriate and requires all service recipients be gainfully employed, actively pursuing employment, or participating in vocation education/rehabilitation;
(K) A weekly schedule of all program services and service recipient activities for each day specifying the type of service/activities and scheduled times;
(L) A requirement that the facility provide to the service recipient, upon admission, a written statement outlining in simple, non-technical language with all rights of client ' rights.
These rights must include provisions to prohibit:
1. Denial to the service recipient of adequate food, treatment/rehabilitation
activities, religious activities, mail or other contacts with family as punishment;
and
2. Confinement of the service recipient to his/her room or other place of isolation as punishment. This does not preclude requesting service recipients to remove themselves from potentially harmful situations in order to regain self-control.
V- PERSONNEL AND STAFFING REQUIREMENTS:
(1) Direct treatment and/or rehabilitation services must be provided by qualified alcohol and drug
abuse personnel who as a requirement of employment were subject to a criminal background
and abuse registry check.
(2) A physician must be employed or retained by written agreement to serve as medical consultant to the program.
(3) The facility must provide at least one (1) on-duty staff and on-site member certified in cardiopulmonary resuscitation (CPR), and trained in first aid, abdominal thrust, and standard precautions of infection control.
(4) During waking hours, the facility must maintain an on-duty and on-site staff-to-service recipient ratio of at least one (1) to sixteen (16) when service recipients are present. During sleeping hours, facilities must provide at least one (1) awake on-duty and on-site staff person for each thirty (30) service recipients.
VI:SERVICE RECIPIENT ASSESSMENT REQUIREMENTS:
(1) The facility must document that the following assessments are completed prior to development of the Individual Program Plan (IPP); re-admission assessments must document the following information from the date of last service:
(a) Assessment of current functioning according to presenting problem, including history of the presenting problem;
(b) Basic medical history and determination of the necessity of a medical evaluation and a copy, where applicable, of the results of the medical evaluation;
(c) Screening to identify service recipients who are at high risk for infection with TB , sexual disorders , and communicable diseases.
(d) Assessment information must include employment and educational skills, financial status, emotional and psychological health, legal issues, community living skills and housing needs, and the impact of alcohol and/or drug abuse or dependency on each area of the service recipient’s life functioning; and
(e) A six (6) month history of prescribed medications, frequently used over-the-counter medications, and alcohol or other drugs, including patterns of specific usage for the past thirty (30) days.
VII:SERVICE RECIPIENT RECORD REQUIREMENTS:
The individual service recipient record must include the following:
(a) Documentation on a medications log sheet of all medications prescribed or
administered with the date of the prescription, date of administration, type, dosage, frequency, amount, and reason;
(b) Documentation of the service recipient’s employment related problem or problems and goal or goals on the INDIVIDUAL PROGRAM PLAN, and the service recipient’s progress or lack of progress towards meeting the goal or goals in the progress notes, or clinical justification for an exception to the policy and procedure;
(c) A list of each individual article of each service recipient’s personal property valued at one hundred dollars (300 SR , cash or credit card) or more including its disposition, if no longer in use;
(d) Reports of medical problems, accidents, seizures, and illnesses and treatments for such accidents, seizures, and illnesses;
(e) Reports of significant behavior incidents;
(f) Reports of any instance of physical holding or restriction with documented justification and authorization;
(g) A discharge summary which states the date of discharge, reasons for discharge, and referral for other services, if appropriate; and
(h) An aftercare plan which specifies the type of contact, planned frequency of contact, and responsible staff; or documentation that the service recipient was offered aftercare but decided not to participate; or documentation that the service recipient dropped out of treatment and is therefore not available for aftercare planning; or verification that the service recipient is admitted for further alcohol and drug treatment services.
VIII- HEALTH PROVISIONS FOR SERVICE RECIPIENTS:
(1) The facility must have provisions that address the following health issues while the service recipient is at the facility:
(a) Nutritional needs;
(b) Exercise;
(c) Weight control;
(d) Adequate, uninterrupted sleep; and
(e) Designated smoking areas outside the building.
(2) The facility must educate and encourage service recipients in independent exercise of hygiene, and grooming practices, as appropriate.
(3) The facility will encourage the use of adaptive equipment including but not limited to dental appliances, eyeglasses, and hearing aids if used by service recipients.
References:
1. Polcin, DL; Korcha, R; Bond, J; Galloway, G (2010). "What Did We Learn from Our Study on Sober Living Houses and Where Do We Go from Here?". J Psychoactive Drugs. 42 (4): 425–33. doi:10.1080/02791072.2010.10400705. PMC 3057870. PMID 21305907.
2. Rosenblatt, Susannah (2008-05-22). "Newport Beach sober-living homes scramble to complete city's permit process". Los Angeles Times. Retrieved 2008-05-27.
3. Wittman. "Affordable housing for people with alcohol and other drug problems". Contemporary Drug Problems. 20 (3): 541–609.
4. Polcin, Douglas L.; Henderson, Diane McAllister (June 2008). "A Clean and Sober Place to Live: Philosophy, Structure, and Purported Therapeutic Factors in Sober Living Houses". Journal of Psychoactive Drugs. 40 (2): 153–159. doi:10.1080/02791072.2008.10400625. PMC 2556949.
5. "Sober House 2 With Dr. Drew - Peep the Cast" vh1.com, February 25, 2010
6. Sweeney, Dan (2017-06-27). "New state law bans sober homes from falsely advertising services and locations". Sun Sentinel. Retrieved 2017-06-30.
7. Polcin, DL; Korcha, RA; Bond, J; Galloway, G (2010). "Sober living houses for alcohol and drug dependence: 18-month outcomes". J Subst Abuse Treat. 38 (4): 356–65. doi:10.1016/j.jsat.2010.02.003. PMC 2860009. PMID 20299175
8. Smith LA, Gates S, Foxcroft D. Therapeutic communities for substance related disorder. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD005338. DOI: 10.1002/14651858.CD005338.pub2.
9. Douglas L. Polcin, Ed.D., MFT and Diane Henderson, B.A.
Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608-1010
