Proposal for Halfway House Facility: in Addiction Rehabilitation

1. Proposal for Halfway House Facility
in Addiction Rehabilitation
- 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 supportand 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 “soberhouse” is defined as a more
accessible transition between hospitalization and life in the community. Its
objective is to promote a social supportsystem for alcohol and substance
dependents who will benefit from the supportive treatment structure in
such a soberenvironment.
“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
purposeof 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.

2. II- Theoretical basisof halfwayhouse in substanceuse 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 supportand 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 accountdifferent 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 conceptualtheoreticalmodels for halfway houses have been
proposed: the family model and the socialmodel.
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 proposesa therapeutic factor.

3. 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- Implicationsfor 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
substanceusers seems to be a low-cost service option. Further, it offers
dignity to the patients while building social supportin 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 supportprocess with reinforcement from
governmental actions.
Services include:
 Drug screenings
 Support group meetings
 Counseling
 Life skill development
 Vocationaltraining
 Financialcourses
 Basic educationclasses
 Anger management therapy
 Driver’s license courses

4.  Computer skills training
 Employability training
 Grief counseling
 Mentoring services
 Self-esteemclasses
 Individual counseling
 Group therapy
 Family therapy
IV - Initial policiesand 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 proceduremust 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;

5. (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 personfor 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

6. 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 RECIPIENTRECORDREQUIREMENTS:
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 SERVICERECIPIENTS:
(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;

7. (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:
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Learn from Our Studyon Sober LivingHousesand Where Do We Go
from Here?". J Psychoactive Drugs. 42 (4): 425–
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907.
2. Rosenblatt, Susannah(2008-05-22). "NewportBeach sober-living
homes scrambleto completecity's permitprocess". Los AngelesTimes.
Retrieved 2008-05-27.
3. Wittman. "Affordablehousing for peoplewithalcohol and other drug
problems". ContemporaryDrug Problems. 20 (3): 541–609.
4. Polcin, DouglasL.;Henderson, Diane McAllister(June2008). "A
Clean and SoberPlace to Live:Philosophy, Structure, and Purported
TherapeuticFactors in Sober LivingHouses". Journal of Psychoactive
Drugs. 40 (2): 153–
159. doi:10.1080/02791072.2008.10400625. PMC 2556949.
5. "SoberHouse 2 With Dr. Drew - Peepthe Cast" vh1.com, February
25, 2010
6. Sweeney, Dan (2017-06-27). "New statelaw banssober homes from
falselyadvertising servicesand locations". Sun Sentinel.
Retrieved 2017-06-30.
7. Polcin, DL; Korcha, RA; Bond, J; Galloway, G (2010). "Soberliving
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Alcohol Research Group, PublicHealth Institute, 6475 Christie Avenue,
Suite 400, Emeryville, CA 94608-1010