NARSS Montana

Many rural areas have limited recovery support services for individuals struggling to overcome addiction. Following treatment, individuals return home to an unsafe recovery environment and minimal recovery-oriented social support. We seek to address this problem by:

1. Providing daily peer-led (individual and group) recovery support services in a community center setting.
2. Providing culturally relevant support and activities.
3. Providing recovery focused housing opportunities.
4. Developing a culture of recovery, and a recovery-oriented system of care in the community.

This program model is grassroots and peer-led. It strongly depends on a small group of recovering people dedicating time and energy in service to their community. The growth of our recovery community over the past couple of years, is in large part, the result of staying true to the model and retaining our autonomy. We believe that this is a model that can be replicated in other rural areas in a very cost effective manner.

As pointed out by the Jail and Justice System Assessment (2017), the county poverty rate was about 60% higher than the state rate (p. 10).  Lake County very limited outpatient addiction treatment programs, and no agency or center offering inpatient or residential treatment programs (p. 12).  43.5% of the county arrest profile is directly drug or alcohol related, with an even higher indirect drug or alcohol related correlation for crimes committed while using or achieving financial resources to use (p. 15).    https://www.lakemt.gov/sheriff... 

This information gives some important issues to consider:  The jail is over-crowded and not equipped to treat addiction problems, there is extremely limited local resources for people to turn to for help, many people in the county are not in a financial position to pay for out of the area treatment, and the arrest records show that substance abuse is a serious corollary issue for public safety.

Furthermore, aside from the program we are developing, Lake County (located on the Flathead Indian Reservation) does not offer any:

• Culturally relevant treatment options
• Sober living/recovery residence programs
• Recovery based community centers
• Recovery-oriented system of care collaboration
• Long-term recovery management support

Never Alone Recovery Support Services are nested strongly within the framework of Recovery-Oriented Systems of Care (ROSC), and the Recovery Management (RM) and Peer Support models being used successfully across the nation.  This framework and its models for intervention are based on the American Medical Association’s premise that addiction is a primary, chronic, progressive, and often fatal disease, that requires long-term care.

Most clinical treatment options in Montana follow an acute rather than chronic model of care, offering brief 30-day inpatient stays with little to no long-term aftercare.  Clients are released back into their old environment, told to sign up for outpatient services, and then expected to figure out how to navigate recovery from there.  Never Alone Recovery Support Services work to fill this treatment gap.  Part of our purpose is to create connection between those new to recovery and those who have achieved long-term recovery.  We believe that individuals (peers) in long-term recovery are in a unique position to share firsthand knowledge and experience into how this disease can be kept in remission.

Our program provides:

• Culturally relevant recovery support
• A recovery residence program
• A recovery based community drop-in center
• Recovery-oriented system of care collaboration
• Long-term recovery management support

We are located on the Flathead Indian Reservation. We work closely with the CSKT Tribal Council, Tribal Health, and Salish Kootenai College.  Our board of directors is made up primarily of tribal members.  60-percent of the population we serve are tribal members or tribal descendants.

Many of our community members are skeptical of agency-led solutions.  Our solution is peer-led, and does not trigger the feelings of historical trauma and anxiety that come up when participants are required to sign up with the larger treatment agencies and programs.

Our program is grassroots, it is evolving naturally according to the needs of our community, it is almost entirely volunteer based, and the participants are the primary developers.  We are a Recovery Community Organization (RCO), all of our board members are in recovery themselves, and we encourage everyone in the recovery community to be part of our board meetings and help guide these projects.

We believe we fit well into the Indigenous Communities Fellowship. Our solution directly addresses the dimension "Improve healthcare access and outcomes, including around mental health and substance use disorders".

We align with the following Solve core values:

1. Optimism- Our solution has the potential to transform the way addiction is addressed in other tribal communities
2. Partnership- We work closely with multiple organizations, and share our program model freely for replication purposes
3. Open Innovation- Our model is unique in the state of Montana
4. Human-Centered Solutions- We are grassroots, and our participants have a voice in the direction our organization moves

As far as we know, our solution (program model) is completely unique in the state of Montana. Several agencies have been supporting us and watching us grow; however, because their funding is controlled by Medicaid rules, they are not in a position to replicate the kind of community led model we are providing.

Our solution is unique in the following ways:

• We are completely peer-run, autonomous, and widely respected in our community
• Our model is very cost-efficient (we do not need to pay a group of clinicians to run this model)
• We have implemented a large cultural element into our program
• Fellowship and community are a key focus of our program
• Our participation numbers have quadrupled over the past 2-years
• Our model addresses addiction as a chronic, rather than acute issue, and we provide long-term immersion into a recovery community so that we keep people engaged for years rather than months

Our solution is a program model/process to initiate and sustain the recovery efforts of individuals struggling to overcome addiction.

Our primary technology is cultural practices, social/community modeling, and behavioral health modeling. We are leading by example, sharing with other communities a model which can be cost effective, culturally relevant, and produce powerful results. 

We operate on a shoe-string budget, our funds are limited to donations and small grants. So far, the technology we have incorporated includes online zoom meetings, a Facebook group page, a website, and group chats.

We would like to develop or have access to:

1. A recovery-based application that links us to other peer-run programs across the nation, so we can share program ideas and support each other in our recovery journeys
2. Non-clinical (peer support) software designed to keep participant information, track progress, and track outcomes.

Our solution does not utilize widely used and accepted technology. However, there are some programs out there that use some of the same framework and theory. We work in partnership with, and partially mimic a model widely used in Kentucky called Recovery Kentucky, see their outcomes here:

https://www.fletchergroup.org/home-page/our-outcomes/

Our model also falls under the same framework as William White's (peer support, recovery management, recovery-oriented systems of care) models. We also use White Bison's Well-briety framework. See the following for more information:

Recovery Monographs, Volumes 1 & 2 

https://www.authorhouse.com/BookStore/BookDetails/495996-Recovery-Monographs-Volume-I

And see the following articles on Wellbriety and peer support:

http://www.williamwhitepapers.com/pr/Recovery%20Coach%20Roles%20%26%20Responsibilities%20Coyhis.pdf

http://www.williamwhitepapers.com/pr/2002RecoveryinNativeAmerica.pdf

Our story is a form of qualitative research that supports our theory of change.

Our solution has already had a large impact on our community. We started with 7-people (recovering addicts) in October 2017. Our community did not have anywhere for us to meet, and there was no local recovery-oriented system of care in place.  We started a support group that met several time a week. Withing 1-year our participation numbers tripled. In October of 2018 we opened a Recovery Hall community center and started providing daily peer support services, our participation numbers tripled again. In 2019 we formed as a 501c3, continuing our recovery support services, and our participation numbers quadrupled. In January 2020 we opened a men's recovery residence, our participation level continues to grow and many of our first and second year participants now have long-term recovery.

The steady expansion, professional recognition, and program implementation of peer support services across the country may be indicators that these services have been found to be a good match for the treatment of substance use disorders.  McLellan et al. (1998) found that community-based services such as peer support “substantially improved the outcomes of addiction treatment”.  Research conducted by Boisvert, R. A., Martin, L. M., Grosek, M., & Clarie, A. J. (2008), found that participation in peer support communities significantly reduces the risk of relapse among participants, and promotes social investment into recovery that produces skills benefiting the society at large.

According to Chapman, Blash, Mayer, & Spetz (2018), “Findings from numerous randomly controlled trials suggested the potential for peer providers to improve outcomes, including reducing hospitalizations, enhancing self-efficacy and quality of life, and increasing patient activation”.  As participants engage in peer support, they are surrounded by peers in a recovery setting, learning how to socialize in healthy ways.  This element of social connection in early recovery is vital in establishing new behavioral patterns and learning new ways to meet basic human social needs in a safe and healthy setting. 
 

We are in a rural area.

We currently serve 73-participants.

We expect that number to reach 100 in the coming year.

We expect to see gradual growth across the board for participation numbers over the next 5-years.

We are currently in the process of moving our recovery community center to another location, this will be permanent and will help establish our program in an accessible location, thereby encouraging greater participation.  This year we are focused on implementing an evidence-based program called Recovery Dynamics for the local drug court and our recovery residence participants. We are also in the process of developing a strong cultural curriculum and implementing a program evaluation component to track outcome data.

Our 5-year goal includes expanding our residential services to include a women's facility, and share the program model and outcome data with other communities.

1. We need to become licensed by the state as a level 3.1 facility so that we can secure certain funds we can't currently access.
2. We need to update and develop a sustainable business plan that addresses the changes our organization is facing.
3. We need to finish developing contracts with tribal health and department of corrections as funding sources. We have started the conversations, but need to see it put into motion.

1. We are currently in the application process, not sure what barriers we face yet with the state.
2. We are working with Hopa Mountain 501c3 to develop a sustainable business plan, everything was put on hold during this covid-19 quarantine
3. A lot of this barrier will be resolved when we get our level 3.1 certification. We are currently negotiating with tribal health on a Pass-through contract, it just takes time.

N/A

We currently do not have any paid staff members, we hope to change that this year if we can find the funding.  Over the past 2-years, all of our staff have been volunteers.

We currently have 12 individuals volunteering in significant ways, and several others who play smaller important roles.

Our Board of Directors consists of 3 addiction counselors, a peer support specialist, 2 cultural advisors, and a harm reduction specialist. We all have long-term recovery from addiction.  We train our participants in recovery coaching so that they can be qualified to provide services.

We are a strong recovery community organization, we understand the process of recovery, we hang out together, help each other, and know each others stories. New participants that enter the program almost always know some of us. Our program is well respected in our community.

We provide services for the following partners:

• 20th District Drug Court
• Tribal Health
• Probation and Parole
• Salish Kootenai College

Our clinical supervision and clinical referrals are done by:

• The Sunburst Foundation

Our community recovery hall is provided by:

• CSKT Tribal Council and Tribal Lands Department

We have recieved Grant funding from:

• Morgan Family Foundation
• George Hamill Memorial Fund
• Kendeda Fund
• Headwaters "Go-Grant"

As a 501c3, we are less than a year old.

This is our weak spot right now. We are trying to put together a sustainable business plan, but everything got put on hold due to covid-19.

We are working on developing funding contracts with the following:

• Tribal Health
• Department of Corrections

We are in the application process to be certified to bill Medicaid, but that would only be for the residential services.

We are working with Hopa Mountain and have good support in getting these things done, but it is taking time and we need some financial help to get us through the process.

We want to be part of a larger community of problem solvers. The problems our communities face are diverse and complex. If we begin collaborating and sharing solutions, then we do not need to re-invent the wheel in each community.  There are people in my community addressing issues such as food sovereignty and language/culture preservation. As part of the Solve community, we can help our community link with problem solvers in other communities working on the same issues.  We know that other Indigenous communities are trying to figure out how to address the addiction issue, maybe we can share what we are doing here to help them make a difference.

We would like to collaborate with other organizations across the country that are running similar programs.  How are they funded? Did they have to become Medicaid providers? What cultural elements do they utilize? Are they tracking outcomes, what tools are they using in their tracking?

We would like to share a model of recovery that is working very well here, and see if it can be replicated in other communities.

I could not find any Solve partners that are addressing the issue we are addressing. Maybe our organization will be the first, and new partners can reach out to us. We can be trail-blazers for those coming later.