Doors to Recovery · Meanwhile, though, my son was addicted, so you’re staring at withdrawal. He said, “Dad, I can get methadone.” So that first afternoon I gave him 50 dollars

Doors toRecoveryCommunity Asset Mapping Report

www.transformingyouthrecovery.com

Transforming Youth Recovery P.O. Box 5011Reno, NV 89513

(775) 360-5672www.transformingyouthrecovery.org

Permission to reproduce in whole or part for use in educational and other not-for-profit groups is granted with the acknowledgment of Transforming Youth Recovery as the source on all copies.

The contents of this publication is based on work by sr4 Partners LLC under contract and sponsored by Transforming Youth Recovery.

© Transforming Youth Recovery: July, 2015

http://www.transformingyouthrecovery.org

DOORS TO RECOVERY - COMMUNIT Y ASSE T REPOR T | 3

Transforming Youth Recovery

Table of Contents

What do you do? Where do you turn? ..............................................4

Pathway to Recovery ...........................................................................8

Introduction..........................................................................................10

Methodology ....................................................................................13

Influential Connections ........................................................................18

Bristlecone Family Resources ...........................................................23

Communities in Schools ...................................................................26

Community Health Alliance ..............................................................28

Department of Veterans Affairs, Addictive Disorders ......................31

Fellowship of Christian Athletes .......................................................33

Join Together Northern Nevada .......................................................35

Life Changes, Inc. .............................................................................37

Nevada State Office of Rural Health .................................................38

Nevada Youth Empowerment Project ..............................................41

Northern Nevada HOPES .................................................................43

Reno Sparks Tribal Health Center .....................................................45

Ridge House .....................................................................................48

Step 1, Inc. ........................................................................................51

STEP2 ...............................................................................................53

UNR – NRAP and CASAT ..................................................................56

Volunteers of America ......................................................................59

Washoe County Crossroads Program ...............................................61

Washoe County Department of Social Services ...............................63

Washoe County School District ........................................................66

Observations ........................................................................................68

Recommendations ...............................................................................71

Bibliography .........................................................................................74

4 | DOORS TO RECOVERY - COMMUNIT Y ASSE T REPOR T


What do you do? Where do you turn? By Adrian1

Over about the last year and a half, a lot of stuff was disappearing from my house. My son was the only one who had access to most of those things. I didn’t want to believe that he would do it, so I basically ignored it for a long time. Then this past January, there was a burglary, and by that time I’d put in a security camera system. So I went back through the tapes and found a recording – of my son taking a shotgun out of my bedroom, and then later that day taking a pistol out of my bedroom. This was proof of what was going on. So I confronted my son and said, “Hey, what’s going on here? I’m not stupid. I’ve let you get away with this for a long time. But now I want to know what’s going on.”

He says, “I wouldn’t take anything from you Dad.” But at a certain point he finally broke down and said, “Hey, Dad, I’m addicted to heroin. I’ve been steeling your stuff to support my habit. I basically started out with Xanax and Percocet and just pain pills, but they became really, really expensive. And I did become addicted to those pills. So this kid who was selling me the pills said, ‘Try heroin, man, it’s like a third of the cost and a lot better high.’”

So he started doing heroin about a year, year-and-a-half ago. He’s a college student. He lives in my house. I gave him money every month because he doesn’t work – he’s taking 15 credit hours so I’m trying to make it…actually, I’m an enabler, okay? Let’s face the facts, Dad’s been an enabler.

Now I’m faced with this situation that my son’s addicted to heroin. So I get on the computer and try to figure out what do I do, who do I talk to, how do I approach this? I went through probably 50, 60 web pages in one night just looking for some kind of rehabilitation. I found lots of different places that offered addiction treatment, detox and long-term rehab care. But the first thing I didn’t know was, what does he need? I just didn’t know.

For the next three days I stayed on that computer. I looked at websites. I started to make calls. Meanwhile, though, my son was addicted, so you’re staring at withdrawal. He said, “Dad, I can get methadone.” So that first afternoon I gave him 50 dollars to go buy it – from the same guy he’d been buying the dope from! I didn’t like that at all, but I didn’t know what else to do. And then we do it again, at 50 dollars a pill! They knew he was withdrawing, and he would have to pay. We did that Saturday, Sunday, Monday and maybe Tuesday, while I continued to search these websites.

1 A pseudonym



I was calling places, but on Monday I also called my longtime high school friend, confidant and also my attorney, a guy that I would tell anything to. I tell him hey, Dorian’s addicted to heroin, I don’t know what to do. You got any ideas? He said, “Let me do some research and get back to you.” He calls me back the next day and says, I got this person, you can give her a call, and that person was Stacie Mathewson. I call her and leave a message. She calls me back two, three hours later. And she says, “Okay, what’s happened?”

So I told her. And she shared her story with me, about her experience with her son. She tells me, “Do what you got to do right now to not allow the withdrawals to start. Let me make some phone calls and get back to you.” For the first time in four or five days I finally felt like I had connected to someone…a trustworthy person that I was talking to…someone I could depend on that wasn’t trying to sell me a 60-thousand-dollar rehab in Malibu where, by the way, you can bring your cell phone and your computer and it’s pretty much a resort.”

While I’m waiting to hear back from Stacie, I start talking to a guy who finally found me a rehab place in Utah that sounded pretty good – but I don’t know, this guy who’s helping me is from an 800 number that I found on a website. When I hear back from Stacie, she gives me a name to call. This feels completely different to me. I finally have someone I’m connected with, through the right channels, through my trusted sources, you know, stellar people in the community.

So I call this guy, Steve Burt, who’s executive director of an organization that provides transitional housing and substance abuse recovery. It’s now Wednesday. We started all this on Saturday, so we’re four days into it. Steve listens to my story and says, “Let me make a couple calls and get back to you.” He calls me back three hours later and suggests that I get in touch with John Firestone, who has a place called The Life Change Center.

I get ahold of John that afternoon and he says, “A friend of Steve Burt is a friend of mine, so come in at 9 o’clock tomorrow morning.” I was thrilled. I had someone who sounded like he was really willing to help me – which, it ended up, he did.

Here’s the thing about my son: he’s been taking 15 hours of courses for the last several quarters and making good grades – while feeding his heroin addiction. We were thinking maybe the best thing was not to put him through a hard-core detox and 30-day rehab, but to keep him



in school, get him some counseling, get him on a methadone program and gradually get him back to a normal life. It’s going to take a lot of hard work and take a long time, but we can do it.

So my son and I spill our guts to John Firestone and he says, “This is how we can do this. We’re going to get your insurance, get a prescription for methadone and get Dorian set up with one of our counselors.” He got his first legal dose of methadone that day, came in and saw the counselor the next morning, and he’s been seeing the counselor twice a week ever since. Of course, we need additional counseling: for me, for being an enabler.

I think the theme of my story is that here I am, going through life, thinking everything is fine, and suddenly like a brick – it hits me when my son tells me he’s addicted to heroin. So the theme is, what does a parent do? Where do they turn?

I know I was super fortunate. I was born here. I went to high school with my confidant. He had a connection with Stacie, and Stacie knew all the right people. So I came into the recovery system from the top. Most people aren’t that lucky.

Most people have to make that cold call. I made some of those calls, before I found my trusted source. I can’t tell you how frustrating it is to make those phone calls and not get any answers. And you’re just sitting there knowing that your kid is way messed up and you’re desperate to help him…but what do you do, where do you turn?





A PATHWAY TO RECOVERY:

THE STORY OF A FATHER AND SON

Dad confronts son

1 day

1

1 day

Son admits he’s addicted to prescription meds and

then heroine

2

1 day

Dad tries to �gure out what son needs and

struggles to �nd an answer

3

Stacie calls dad and asks 'What's happened?'

1 day

7

Son sees counselor twice a week and works

treatment plan

13

4 days

Stacie connects dad to Steve Burt at

Ridge House

8

4 days

Steve connects dad with John Firestone at The Life

Change Center

9

5 days

Dad and son meet with counselor at The Life

Change Center

10

6 days

Son meets with a counselor and puts together a

treatment plan

12

Son tries to stave o� withdrawl by purchasing

methadone illegally

1-3 days

M

4

1 day

Dad calls long time friend, con�dant and

attorney

5

1 day

Attorney calls Stacie

6

5 days

Son gets �rst legal dose of methadone

M

11



A PATHWAY TO RECOVERY:

THE STORY OF A FATHER AND SON

Dad confronts son

1 day

1

1 day

Son admits he’s addicted to prescription meds and

then heroine

2

1 day

Dad tries to �gure out what son needs and

struggles to �nd an answer

3

Stacie calls dad and asks 'What's happened?'

1 day

7

Son sees counselor twice a week and works

treatment plan

13

4 days

Stacie connects dad to Steve Burt at

Ridge House

8

4 days

Steve connects dad with John Firestone at The Life

Change Center

9

5 days

Dad and son meet with counselor at The Life

Change Center

10

6 days

Son meets with a counselor and puts together a

treatment plan

12

Son tries to stave o� withdrawl by purchasing

methadone illegally

1-3 days

M

4

1 day

Dad calls long time friend, con�dant and

attorney

5

1 day

Attorney calls Stacie

6

5 days

Son gets �rst legal dose of methadone

M

11



INTRODUCTION

So, where does someone turn in Washoe County? What resources are available and how might those resources combine to provide the best possible continuum of care? These ques-tions and more are explored in this community asset mapping report.

The 2015 Community Health Needs Assessment conducted for Washoe County identified three pressing substance abuse issues in the area:

1. Prescription drug and heroin abuse

2. The increased acceptance of marijuana as ‘harmless’

3. Mental health issues that intersect with alcohol and other drug abuse

The report states that the current private substance abuse treatment facilities in Washoe County can be effective but the public programs are underfunded for the current community demand. The gaps in service currently identified by the 2015 Community Health Needs As-sessment in regards to substance abuse include:

1. Insufficient outpatient capacity and beds

2. Lack of sober living options for those in early sobriety

3. A lack of information sharing and meaningful integration between primary care, mental health services and substance abuse prevention/treatment providers

4. A general lack of mental health wellness and illness prevention

The 2015 Community Health Needs Assessment conducted for Washoe County also indi-cates that:

• Washoe County has higher rates of alcohol consumption than other counties in Nevada and the rest of the nation.

• There is a critical shortage of mental health professionals in Washoe County and North-ern Nevada. Additionally, according to the report, most counties surrounding Washoe, including those in Northern California and Southern Oregon are also federally defined mental health shortage areas meaning the practitioners in Reno may be overburdened with residents of rural surrounding areas seeking care in Washoe County.



• Of those serviced in Washoe County’s mental health court, 85% has a co-occurring dis-order of substance abuse.

• Adults in Washoe County have a much higher suicide rate (22.3 per 100,000 popula-tion) than both the state of Nevada and the United States.

• Washoe County’s teen attempted suicide rate is well above the national average – in 2013 21% of high schoolers considered suicide and 14% attempted suicide – nearly double the national rate.

• Patient’s under the influence of alcohol or drugs accounted for roughly one-third of the emergency room visits in Washoe County during 2013.

• In Washoe County, nearly 9% of adults are estimated to be heavy drinkers – higher than Nevada overall and the U.S. – and can be attributed to the high rates of alcohol con-sumption among the white, non-hispanic populations in the county.

• Washoe County drug overdose rates have been higher than the rest of Nevada since 2007 and continue to climb through 2011.

• Nearly half of all drug overdose deaths in Washoe County from 2008-2012 were due to prescription drugs.

• Most recent data indicate that 71% of high school students in Washoe County have consumed alcohol at least once and females are more likely to do so than males.

• Rates of binge drinking among adults were higher in Washoe County than Nevada and the United States in 2013.

• Drug overdose deaths have steadily increased in Washoe County and Nevada since 2002.

• Death rates due to prescription drugs and opioids were higher than illegal drug over-dose death rates from 2004 through 2009. Illicit drug deaths, however, have increased since 2010.

• The most recent Youth Behavior Risk Survey data shows that in 2013, 28.2% of students in Washoe County had smoked marijuana in the past month.

• According to the Nevada State Office of Rural Health’s 2013 Edition of the Nevada Ru-ral and Frontier Health Data Book, in 2012 Washoe County had a total of 361 licensed alcohol, drug and gambling counselors, 14 licensed clinical professional counselors, 69 licensed psychiatrists and 143 licensed psychologists.



Although reports such as those listed above and several other organizations have compiled various lists of local prevention, treatment and recovery support services, Doors to Recovery (DTR) has initiated a community asset mapping effort to better understand how such services are coordinating and combining to provide care and support to individuals and families in Reno and Northern Nevada. In doing so, asset mapping activities allow Doors to Recovery, a newer organization, to make meaningful connections and create a holistic, more compre-hensive inventory of prevention, treatment and recovery assets than has been previously available to those in need of such information.

The longer-term goal is to create a dynamic web-based inventory of assets that includes such details as: client fee scales and other costs, wait times, eligibility requirements, population, gender, ages served, availability of extended services and any other pertinent information which may aid in access to needed care and support. In the case of in-patient services, we also seek information regarding numbers of beds, how many beds per room, required and typical length of stay, types of classes and counseling offered, additional services available, provision and nature of aftercare, and any other pertinent information which may be of val-ue The information collected and shared in this report will create the foundation for the dynamic, web-based inventory of assets. Additional work remains to ensure the inventory is comprehensive.

This report is meant to be a catalyst for connecting people to resources and informing a network of coordinated care and support in and around Reno. DTR’s ongoing work will be to strive for a better understanding of how individuals and families are trying to access or are moving in and out of services and programs; this will ensure advocacy efforts can target the right capacity-building efforts to address any gaps or barriers in pathways to recovery. At this starting point, Doors to Recovery aims to enhance existing network connections and activities to purposefully contribute to what is working and make visible the paths people are seeking to find.



METHODOLOGYOverview of Asset Mapping

Asset mapping is a dynamic discipline for creating an inventory of the people, places and groups within a community that can combine to inform and shape capacity-building efforts. The discipline of asset mapping has roots in the practice of community design where local talents and gifts are mobilized to promote a healthy and thriving community of people.

The true value of the mapping discipline is the creation of an ongoing process of outreach and relationship building. A few known benefits of asset mapping include:

• Cultivating new relationships and connections to weave together people, places, and groups with common goals;

• Offering a unique perspective to reveal gaps in service or barriers to care and support;

• Clarifying the pathways to the care and support that people and families may need – to help everyone see where to go and what to do in practical terms and ways.

Every community is rich in the talents and experiences it has to offer. Typically, only a fraction of a community’s assets are accessed fully by people – whether they are in recovery from a substance use disorder, or seeking to avoid the risks associated with alcohol and other drugs. The intent behind asset mapping for prevention, treatment and recovery support is to in-crease access to resources, information and the services needed to be well.

Based on national asset research being led by Transforming Youth Recovery, potential com-munity assets for building prevention, treatment and recovery support capacity are a com-posite of seven primary categories:

1. Advocacy and Public Policy

2. Family Support and Services

3. Health and Wellness

4. K-12 Prevention

5. Recovery Support

6. School-Based Recovery Support: High School, Community College and Collegiate

7. Treatment and Counseling

Asset Mapping Process

These assets combine to protect, support and serve people and the families that are address-ing the risks associated with alcohol and other drugs within their communities.

There are three main steps in community asset mapping: (1) preliminary inventory, (2) dedi-



cated interviews with influential connections and (3) publication of assets for profile creation. Below the steps are described.

Step 1: Preliminary Inventory

Research and investigation was undertaken to create a preliminary inventory of the people, places, groups, programs and services (community assets) that are contributing to preven-tion, treatment and recovery efforts in and around Reno through secondary data collection.

The following approaches were utilized to create the preliminary inventory:

1. Information Referral: Review of contact and resource lists and documents that were known to Doors to Recovery.

2. Social Media: Sourcing of professionals and organizations in and around Reno through LinkedIn and Google+. In the prevention, treatment and recovery field many assets or service providers are individuals. Therefore, these social media data sources allow for the identification of assets even when they may not do marketing, advertising or have a website.

3. Keyword Searches: Sourcing of professionals, programs, services and places through web-based keyword web searches.

This preliminary inventory resulted in a list of 225 distinct assets.

Step 2: Dedicated Interviews with Influential Connections

Cross-referencing of data sources and subsequent analysis was applied to identify 10-20 community-based assets that appeared to present themselves as prospective “influential connections” within the network of those working to provide prevention, treatment or re-covery care and support in the Reno area. This identification came from an evaluation of perceived reputation, citations across data sets and representation on resource lists and di-rectories. The initial listing of prospective influencers in and around Reno includes 18 assets:

1. Bristlecone Family Resources

2. The Children’s Cabinet

3. Communities in Schools (CIS)

4. Community Health Alliance

5. Department of Veterans Affairs Medical Center

6. Join Together Northern Nevada

7. Nevada’s Recovery and Prevention Community (UNR N-RAP)

8. Nevada Rural Hospital Partners

9. Nevada State Office of Rural Health, University of Nevada School of Medicine



10. Nevada Youth Empowerment

11. Quest Counseling and Consultation

12. Reno-Sparks Tribal Health Care Center

13. The Ridge House

14. Step 1, Inc.

15. STEP2 (Light House of the Sierra)

16. Volunteers of America

17. Washoe School District Substance Abuse Intervention Program (SAP)

18. Northern Nevada HOPES

(Note: Two additional influential connections were added during the interview process; interview notes are included in the following section)

Each of these influential connections was invited to participate in a dedicated interview (face-to-face or by phone) with the intent to better understand their programs and services, help identify assets that may not be known to the mapping team and identify “next level data” that may be available to help enhance access to care and support.

The type of next level data that may be available can include:

1. General Services Detail: Regularity and frequency of services; Client fee scales and other costs; Participation enrollment and wait times; Population served (gender, ages, eligibility); Availability of extended services; Other pertinent access information or re-quirements.

2. In-Patient Services Detail: Numbers of beds and how many beds per room; Required and typical length of stay; Types of services, classes and counseling offered; Additional services available; Provision and nature of aftercare and support; Other pertinent ac-cess information or requirements.

3. Qualifications Detail: Licenses, certifications or recognition by any governing entity; Nature and frequency of oversight; Outstanding credits, demerits or public reviews.

4. Recovery Data Detail: Reporting practices such as long-term data regarding recidi-vism, maintenance of sobriety or improved life experiences.

The community mapping team found that semi-structured interviews were often not the most effective way to collect all of this next level data and therefore recorded the relevant informa-tion when shared by the interviewee but did not push for every detail. An alternative method for complete data collection will be pursued by Doors to Recovery through their web-based inventory of assets.



In addition to the collection of data for a fuller asset inventory, the opportunity to connect these influencers with the intentions behind the Doors to Recovery project was of importance in terms of near-term objectives. Specifically, working collaboratively with these individuals to identify support gaps and better understand service pathways (When do people call you? How do they engage or get started? And, what do they do next?) for individuals accessing these assets.

Dedicated interviews with influential connections aim to start the process of defining the landscape for assets in and around Reno from a network perspective. Below is a complete list of the questions that members of the asset mapping team planned to ask in advance of each meeting. That said, team members adjusted the line of questioning to the interest and efforts of the interviewee.

1. How do you serve this community?

2. When people come here, what do they experience? What is the continuum of care?

3. On first contact with you or this organization, what should someone expect?

4. What populations do you typically serve?

5. Who gets the most value out of your services?

6. What methodologies, techniques or principles do you utilize?

7. What have people done before they come to you? And where do they go after?

8. Who/what organizations do you consider key contacts for you or your organization?

9. And whom do you go to for advice?

10. Who do you go to for support and encouragement?

11. What type of metrics or information do you collect to measure your success or help those seeking assistance better understand your services?

The results of the dedicated interviews can be reviewed in the next section of this report.

Step 3: Publication of Assets for Profile Creation

Following the interview stage, data records were compiled in order to import a refined in-ventory of 304 community assets into the Capacitype mapping web application (www.ca-pacitype.com), the web-based home for the dynamic inventory of assets. For influential con-nections in and around Reno, these asset records have been expanded to assign “Asset Owners” – those key contacts who can eventually update and modify records with next level data intended to create profiles to assist those seeking care and support for themselves or others. Additionally, asset records can expand to include related resources that can further enhance the ability to easily access and learn about services and programs in the area.

http://www.capacitype.com

http://www.capacitype.com


This final step in the asset mapping activity provides an initial composite of the assets that are contributing to prevention, treatment and recovery efforts in and around Reno. Publication within the Capacitype application enables immediate access to the data and offers initial visual modeling meant to illustrate “pathways to recovery” – those entry points for access, referral and support within the community.

Following this activity, work can be applied over time to support the rapid updating of asset records in a way that will generate informational profiles that can be used to assist those re-ferring or needing care and support. As data is further expanded through survey campaigns and organizational outreach, Doors to Recovery will strive to equip the community with the knowledge and connections necessary to mobilize professionals and volunteers who are working to help people be well.


Bristlecone Communities in Schools

Community Health Alliance

Department of Veterans A�airs

Fellowship of Christian Athletes

JTNN Life Changes, Inc.

N-RAP/CASAT

Nevada O�ce of Rural Health

Nevada Youth Empowerment Project

Northern Nevada HOPES

Reno Sparks Tribal Health Center

Ridge House Step 1, Inc. STEP2 Volunteers of America

Washoe Co. Crossroads Program

Washoe Co. Dept. of Social Services

Washoe County School District

Access Health Care

CASAT



Drug Court

Family Drug Court

Foodbank

New Frontiers


Quest Counseling

STEP2

Trader Joe’s

Triangle Club

UNR

Veteran Court

Washoe County Sheri�’s Department

WestCare

Bristlecone

Catholic Charities

Community Foundation of Western Nevada

Family Resource Centers

Life Change Center

Quest Counseling

Salvation Army

St. Vincent's

STEP2

The Children's Cabinet

UNR


Human Services Network

National Alliance for the Mentally Ill

Northern Nevada Dental Society

UNR

12-Step Meetings

Bristlecone

Drug Court

Health Care for Homeless Veterans

Hospitals

National Assoc. for Social Workers

Veteran Court

Washoe County Crossroads Program

WestCare

Boys and Girls Clubs

UNR


Drug Court

Mental Health Court

Quest Counseling

Reno Police Department


Washoe County Social Services

12-Step Meetings

Drug Court

Nevada Dept of Corrections

Center for Hope

Nevada Works

Problem Gambling Prevention Project

Quest Counseling

Ridge House


Truckee Meadows Community College

Nevada Health Centers

Nevada Rural Hospital Partners

PACE Coalition

Drug Court

Life Changes, Inc.

Salon 7


Transformations


Volunteers of America Homeless Shelters


Eddy House

Koinonia

Ridge House

Bristlecone

Drug Court

Guiding Star Lodge

Native American Connection

Nevada Skies Youth Center

New Frontiers

Reno Sparks Christian Fellowship

Visions Youth Center

Drug Court

Empowerment Center

Freedom House


SAPTA (Kevin Quint)

Drug Court

Job Connect


New Frontiers

Northern Nevada Adult Mental Health Services


Reno Professional Gambling Center

Vitality Center


WestCare

Advocates to End Domestic Violence

American Red Cross


Child Protective Services

Committee to Aid Abused Women

Drug Court

Foodbank


New Frontiers

Norhern Nevada Adult Mental Health Services


Quest Counseling

Renown Pregnancy Center

Ridge House

Safe Embrace


UNR

Washoe County Legal Services

Wells Fargo

WestCare

Bristlecone

Catholic Charities

City of Reno

Drug Court

Eddy House

Gospel Mission

Mental Health Court


Reno Area Alliance for the Homeless


Reno Sparks Gospel Mission

Social Security

St. Vincent's

STEP2

Washoe County



Welfare

WestCare

Bristlecone

Catholic Charities

CCNN Emergency Services


Drug Court

HAWC Community Health Centers

JTNN

Kids Cottage

Mental Health Court


New Frontiers


REMSA

Reno Sparks Police Department

UNR

Veterans Court

Washoe County Sheri�'s Dept

WestCare

Drug Court

Mental Health Court

Quest Counseling

State Department of Public and Behavioral Health



JTNN

Quest Counseling


This network visualization graphic illustrates the influential connections interviewed (in blue) and the other organizations that they coordinate with (in black). This graphic is based on the organizations mentioned during interviews and is meant to be illustrative of the opportunity for future coordination among these organizations.

Influential Connections and the Organizations they Coordinate With







N-RAP/CASAT









Access Health Care

CASAT



Drug Court

Family Drug Court

Foodbank

New Frontiers


Quest Counseling

STEP2

Trader Joe’s

Triangle Club

UNR

Veteran Court


WestCare

Bristlecone

Catholic Charities

Community Foundation of Western Nevada

Family Resource Centers

Life Change Center

Quest Counseling

Salvation Army

St. Vincent's

STEP2


UNR


Human Services Network

National Alliance for the Mentally Ill

Northern Nevada Dental Society

UNR

12-Step Meetings

Bristlecone

Drug Court

Health Care for Homeless Veterans

Hospitals

National Assoc. for Social Workers

Veteran Court


WestCare


UNR


Drug Court

Mental Health Court

Quest Counseling




12-Step Meetings

Drug Court


Center for Hope

Nevada Works

Problem Gambling Prevention Project

Quest Counseling

Ridge House



Nevada Health Centers

Nevada Rural Hospital Partners

PACE Coalition

Drug Court

Life Changes, Inc.

Salon 7


Transformations




Eddy House

Koinonia

Ridge House

Bristlecone

Drug Court

Guiding Star Lodge



New Frontiers

Reno Sparks Christian Fellowship


Drug Court

Empowerment Center

Freedom House


SAPTA (Kevin Quint)

Drug Court

Job Connect


New Frontiers



Reno Professional Gambling Center

Vitality Center


WestCare

Advocates to End Domestic Violence

American Red Cross



Committee to Aid Abused Women

Drug Court

Foodbank


New Frontiers

Norhern Nevada Adult Mental Health Services


Quest Counseling

Renown Pregnancy Center

Ridge House

Safe Embrace


UNR


Wells Fargo

WestCare

Bristlecone

Catholic Charities

City of Reno

Drug Court

Eddy House

Gospel Mission

Mental Health Court


Reno Area Alliance for the Homeless



Social Security

St. Vincent's

STEP2

Washoe County



Welfare

WestCare

Bristlecone

Catholic Charities



Drug Court

HAWC Community Health Centers

JTNN

Kids Cottage

Mental Health Court


New Frontiers


REMSA


UNR

Veterans Court

Washoe County Sheri�'s Dept

WestCare

Drug Court

Mental Health Court

Quest Counseling

State Department of Public and Behavioral Health



JTNN

Quest Counseling








N-RAP/CASAT














N-RAP/CASAT










Drug Court

Family Drug Court

Veteran Court


Drug Court

Hospitals

Veteran Court

Drug Court



Drug Court




Drug Court Drug Court


Drug Court


New Frontiers


Vitality Center


WestCare


Drug Court

WestCare Bristlecone



Drug Court

Mental Health Court




Veterans Court

WestCare


WestCare

Bristlecone

Life Change Center

Quest Counceling

Salvation Army

STEP2

UNR

12-Step Meetings

Bristlecone


WestCare

12-Step Meetings Life Changes, Inc.

Transformations

Bristlecone

Guiding Star Lodge



New Frontiers


Empowerment Center

Freedom House




WestCare

Bristlecone

Eddy House



STEP2


Quest Counseling

Receives Referrals From

Refers Individuals To

Influential Connections and the Organizations they Coordinate With

Influential Connections and the Organizations they Make Referrals To







N-RAP/CASAT














N-RAP/CASAT










Drug Court

Family Drug Court

Veteran Court


Drug Court

Hospitals

Veteran Court

Drug Court



Drug Court




Drug Court Drug Court


Drug Court


New Frontiers


Vitality Center


WestCare


Drug Court

WestCare Bristlecone



Drug Court

Mental Health Court




Veterans Court

WestCare


WestCare

Bristlecone

Life Change Center

Quest Counceling

Salvation Army

STEP2

UNR

12-Step Meetings

Bristlecone


WestCare

12-Step Meetings Life Changes, Inc.

Transformations

Bristlecone

Guiding Star Lodge



New Frontiers


Empowerment Center

Freedom House




WestCare

Bristlecone

Eddy House



STEP2


Quest Counseling

Receives Referrals From

Refers Individuals To

This network visualization graphic illustrates the influential connections interviewed (in blue) and the organizations that they receive referrals from (in black). This graphic is based on the organizations mentioned

during interviews and is meant to be rillustrative of the opportunity for future referrals among these organizations.

This network visualization graphic illustrates the influential connections interviewed (in blue) and the organizations they make referrals to (in black). This graphic is based on the organizations mentioned

during interviews and is meant to be illustrative of the opportunity for future referrals among these organizations.





Influential Connections and What They Said

Bristlecone Family Resources

Contact: Tammra Pearce ([email protected])

Mission or Purpose:Bristlecone is the catch-all for substance abuse treatment in Reno. They don’t have a particular niche in Reno and don’t focus on any one specific population. Bristlecone Family Resources provides comprehensive drug, alcohol and gambling addiction and mental wellness treatment, and post treatment services in northern Nevada.

Description:In total Bristlecone offers 51 beds and is typically serving 360 clients at any one time. The breakdown of beds is as follows: 16 detox/residential, 31 transitional living/housing. Bristlecone also offers transitional housing. Transitional living is typically a 3-6 month program whereas transitional housing typically is 1-2 years. Four of Bristlecone’s beds (residential treatment/detox) are dedicated to Veterans. In order to stay in transitional housing individuals must meet low-income requirements and have graduated from an outpatient or transitional living program. Due to Medicaid provisions, the residential and outpatient services are kept separate. Bristlecone’s biggest program is their outpatient program. Outpatient treatment is typically a 12-18 month program and serves about 260 individuals per year. Bristlecone also offers transitional living on-site and site. Individuals who are a part of Bristlecone’s transitional housing must attend outpatient services, be involved in community service and remain clean and sober.

Bristlecone previously offered a back-to-work program but funding ‘went away’ so this program is no longer offered. Through their services, Bristlecone still does some infor-mal job training and placement, but it is just an extension of their transitional living/transitional housing programs.

Medicaid does not pay for residential treatment. A typical 30-day stay at Bristlecone in their residential treatment program costs $120 a day. Transitional living/housing costs

mailto:[email protected]



$155 a week and includes food, laundry and some transportation. For Veterans, the VA pays $350 per week on their behalf.

Bristlecone’s #1 referral source is the criminal justice system; most of Bristlecone’s cli-ents are court ordered. Bristlecone’s #2 referral source is the VA; Bristlecone does a lot of work for Veterans services. For any non-court ordered admission Bristlecone does a screening and assessment. Part of the assessment is financial as it is important to under-stand who will be paying for the services rendered (self-pay, private insurance, Medicaid or the Substance Abuse Prevention & Treatment Agency). If an individual is not enrolled in Medicaid at the time of assessment, Bristlecone will help to get the individual enrolled in Medicaid.

If a client is referred through the court system, there are a series of specific objectives that must be covered during the initial meeting. Typically potential clients have their ini-tial assessment at Bristlecone though some are completed off-site, prior to their arrival at Bristlecone (for example at the Washoe County Sheriff’s Department). The first meeting with a patient is about laying down the rules and expectations; this includes making it to group and individual sessions, reporting to court, going through drug testing, etc. The Washoe County Drug Court refers approximately 200 individuals per year to Bristlecone.

For those clients who are not referred through the court system but arrive via a VA re-ferral or on their own, the first meeting takes approximately three hours and includes an assessment, paperwork and an interview. Once the initial input is complete, the client sits down with clinicians to create a treatment plan. They then go on Bristlecone’s wait list, which averages 6-12 weeks.

The methodologies utilized at Bristlecone include Cognitive-Behavioral Therapy, mo-tivational interviewing, 12-step for recovery support and peer-based recovery support. Evidence-based practices are key at Bristlecone. However, Bristlecone is currently strug-gling to implement individual-based treatment programs. Medicaid encourages a more standardized treatment program which Bristlecone finds does not produce the same outcomes. Bristlecone bases its treatment planning on the National Institute of Drug Abuse’s “13 Principles of Effective Treatment”. These principles require addressing any obstacles that clients face. Education, job training, child care, transportation, health care, occupational and life skills training are just a few of the needs Bristlecone helps clients address. In Tammra’s opinion, only by tackling a client’s needs head-on does the individual have a real shot at a successful recovery program.

At Bristlecone, patients can undergo a social model of detox. For a medical model, they are referred to WestCare. This social detox model is 3-6 days of supervised detox. To be admitted to one of the 4 beds Bristlecone offers, people have to be cleared by a doctor. More often people go to WestCare for the medical model and then transition from there to Bristlecone’s residential or outpatient programs. Bristlecone finds it challenging to keep these four beds filled so they may transition out of offering the social model and refer everyone to WestCare for medical model detox.

http://www.nida.nih.gov/



Bristlecone interacts with and has partnerships with the following organizations in the Reno area:

1. Washoe County Sheriff’s Department provides referrals

2. The Department of Veterans Affairs provides referrals and funding. Bristlecone was originally overflow for VA transitional living. Now, they are simply a partner service provider

3. SAPTA functions as a payer of last resort

4. The food bank and Trader Joes donate food

5. Redfield, Dermody and Hawkins Foundations provide funding

6. CASAT provides training for peer mentoring and continuing education for counselors

7. UNR provides interns and employees

8. The Triangle Club provides support groups

9. Step 2, Quest Counseling, Northern Nevada HOPES, WestCare, New Frontiers, Ac-cess Health Care (AHC) and other area hospitals/treatment providers are also a part of Bristlecone’s network.

Population Served:Any individual over 18 years of age. The average person in recovery at Bristlecone is a 36 year old white male.

Additional Comments:The Medicaid approval process puts up barriers for treatment; some individuals drop-off or leave before they qualify and therefore don’t receive the treatment they were initially interested in receiving. Currently, Bristlecone has no funding for pre-treatment services, which is challenging when they function off a wait list most of the time. People have to wait for services, sometimes for weeks, and they have lost a lot of people due to this. Ad-ditionally, aftercare is a huge gap for their population. There is not funding so it doesn’t happen. Individualized care is also a big gap; specifically for certain populations (Latino, LGBT, ethnic minorities in general). There is no funding for this. Additionally, Bristlecone is not able to provide the caliber of ancillary services, such as case management, that they would like to provide. This is a top priority for them but currently have no funding to support it. The shortage of halfway houses and transitional living in this area is also a perceived challenge. Tammra stated there are no services for people who can’t make it into these places, or for people who graduate from these services.



Communities in Schools Western Nevada

Contact: Jane Holman ([email protected])

Mission or Purpose:For nearly 35 years, Communities In Schools has been helping students achieve in school, graduate and go on to bright futures. Their mission is to surround students with a community of support, empowering them to stay in school and achieve in life. The story of Communities In Schools began in the 1970s, when Founder Bill Milliken, then a youth advocate in New York City, came up with the idea of bringing community resourc-es inside public schools – where they are accessible, coordinated and accountable.

Description:The program model positions site coordinators inside schools to assess students’ needs and provide resources to help them succeed in the classroom and in life. They part-ner with local businesses, social service agencies, health care providers and volunteers. Whether it is food, school supplies, health care, counseling, academic assistance or a positive role model, Communities In Schools is there to help.

Communities in Schools launched in Western Nevada in 2014. They are currently in 3 schools in Washoe County - 1 elementary and 2 high schools (Booth Elementary School, Hug High School and Innovations High School). They typically operate in Title 1 schools. Their staff work full-time on campus on the school site, providing basic level services - clothing, food security, bus passes, etc. They also provide integrated student support services (wrap around services) through referrals on campuses – such as pregnancy sup-port, behavior modification, drug rehab, recovery, etc. They plan to expand to six area schools next fall.

Typically, CIS gets into a school through principal buy in. Once the principal is bought in, CIS hires and employs an onsite site coordinator for that school.

For their inaugural year, they received funding from their state office. In the future, Jane will be responsible for fundraising. Jane is responsible for raising 80% of operating bud-get. Their state office has received some grants from Wells Fargo and Pennington.

CIS sees themselves as providing wrap-around student support services, helping stu-dents navigate the existing services. For example, they have taken students to Medicaid to get them enrolled and they have worked closely with Catholic Charities and St. Vin-cent’s to figure out immigration information for students. They provide a resource room on each campus that has clothes, snacks, school supplies, etc. All CIS programming is



available to every student on every campus.

Each year, on each campus, CIS implements at least 8 school wide programs; the pro-grams that are delivered depend on the site plan. At Booth Elementary School, CIS WNV coordinated a community-wide school clean-up, resource fair and dinner at Data Night, and expanded more than 20 community services at the school. At Hug and Innovations, CIS WNV hosted college and career nights, immigration workshops and expanded sup-port services to more than 1500 students and their families.

No parental permission is required for level 1 services – those services that help to meet student’s basic needs. Additionally, the families of students can benefit from services such as vouchers for clothes at St. Vincents. CIS has to have parental permission to pro-vide integrated student support services such as behavioral modification, counseling, etc.

The CIS Site Coordinators are the core of the program. Site Coordinators need a BA in a social science and have case management experience. 60% of site coordinator staff are first time college grads. CIS cites their success in providing a one on one relation-ship with a caring adult – it’s something they can’t institutionalize, it’s a matter of being present. Sometimes there are multiple site coordinators at each school. For example, Innovations has two coordinators. The goal is to have two coordinators at each of the schools, which is important for liability purposes. Currently in the program, 80% of site coordinators are UNR graduates and 40% are LGBT.

CIS has relationships with the following organizations:

1. Community Foundation of Western Nevada 2. Reno Youth Network 3. Downing Clinic at UNR4. Bristlecone 5. Salvation Army – refer people to inpatient alcohol and drug rehab6. Step 2 – refer people there7. Life Change Center for Heroin Addiction 8. Quest Counseling9. AA – No parental permission

10. Family Resource Centers

Population Served:Communities in Schools is currently in 26 states and the District of Columbia. Last year, to date, CIS has served over 1.3 million students. The Western Nevada office is one of 187 affiliates nationwide. They have been in southern Nevada and Elko for well over 10 years.



Additional Comments:CIS tracks graduation rates, attendance, services rendered, etc. They have a huge pro-prietary data set that they cultivate.


Contact: Chuck Duarte ([email protected])

Mission or Purpose:As a Federally Qualified Health Center, Community Health Alliance exists to provide high quality health care to any member of the community, regardless of their ability to pay. Community Health Alliance provides an extensive range of health care screening and prevention services, comprehensive primary care for all ages, pharmacy, dental ser-vices (preventive and treatment), management of chronic diseases, episodic illness care, outreach to and services for homeless individuals and families and behavioral health care. In addition, CHA manages a WIC Program (Women, Infants and Children’s Pro-gram), the Northern Nevada Dental Health Program and Adopt a Vet Dental Program. After the merger of HAWC Community Health Centers and Saint Mary’s Mission Out-reach Program on July 1, 2012, Community Health Alliance (the new organization) grew and provided more than 120,000 patient visits in Fiscal Year 2012-2013. In 2014, CHA provided 93,000 visits including medical, dental, nutrition and other services.

Community Health Alliance (CHA) is an organization that builds upon the reputation and history of two known northern Nevada health care providers with similar missions, HAWC Community Health Centers and Saint Mary’s Mission Outreach. The merger com-bining these organizations took effect on July 1, 2012 when Saint Mary’s Regional Med-ical Center was purchased by a for-profit entity, prompting the divestiture of its Mission Outreach programs.

Description:CHA provides an extensive range of health care screening and prevention services, pri-mary care for all ages, pharmacy, dental services (preventive and treatment), integrated behavioral health care and a WIC (Women, Infants and Children) Program. As a Federally Qualified Health Center (FQHC), CHA also provides community education on health issues and outreach to underserved populations. They partner with their patients to en-sure that their health care needs are met.

mailto:cduarte%40chanevada.org?subject=



Patient care is provided in the following programs at CHA:

1. Primary Medical Care

2. Pediatric Care

3. General Dentistry

4. Behavioral Health Care

5. Laboratory Services

6. X-Rays

7. Pharmacy

8. WIC Program

9. Mobile Dental Sealant Program

10. Hospital Dental Program

11. Mobile Dental Restorative Program

12. Northern Nevada Dental Health Program

13. Adopt a Vet Dental Program (Vets only get dental coverage for dental problems in-curred while on active duty. CHA does about 150 dentures for vets per year.)

14. Immunizations

15. Women’s Health Care

16. Breast Health Program

17. Outreach and Enrollment for Nevada Health Link and Medicaid

18. Healthcare for the Homeless

These services are provided at five fixed, brick and mortar health centers and three mo-bile units. In total CHA employs 195 people.

CHA has become the largest provider of dental care to low-income Nevadans. Their mobile dental health care unit and mobile dental hygiene van provides sealant and oral hygiene services for second graders across 22 schools.

Their WIC nutritional program has seven fixed sites that provide supplemental nutrition to women who are pregnant as well as nutrition education for children. The program also has a mobile WIC van.



CHA also runs a school-based health center in Wooster.

In total they have 20 primary health care providers across the five centers. They primarily offer family medicine and pediatrics but recently have added behavioral health.

In August 2015, CHA is opening an additional health center that will focus on integrat-ed chronic care for adults. This will house behavioral health specialists, case managers and psychologists for those who need more intensive care for chronic and co-occurring diseases.

Typically, patients come in through their health clinics, dental services, pharmacies, school-based health centers, nutrition counseling or outreach vans. A screening is deliv-ered to parents and children that assists with identification of issues and CHA makes the relevant referrals. Ideally CHA makes a warm hand-off between the first point of contact (be it family doctor, dentist, pharmacist, etc.) and the behavioral health specialist. This helps with a higher show-up rate than when a patient is just given a referral.

In all of CHA’s programs, they utilize the Waggoner-Integrated Care Model.

They refer patients out for specialty care, in particular for serious mental health issues. As long as the service providers have availability and are able to accept Medicaid, they are an option for CHA’s patients. On top of that they are looking for Spanish-speaking service providers or those known for cultural sensitivity.

Provider education is very important; this is all about reminding those who can make referrals of the types of programs and services that are available. CHA has a monthly provider meetings that brings providers together to help them know when someone needs to be referred and to whom.

CHA stays in contact and collaborates with the following organizations: Northern Neva-da Dental Society, UNR School of Medicine, the local association for community health centers, the National Alliance for the Mentally Ill (NAMI) helps to connect CHA with vulnerable adult mental health populations in the community, Human Services Network (Eric Sean) an advocacy organization that pulls disparate organizations together who have the same mission, such as ‘maintaining funding for mental health services in the Medicaid budget’.

Population Served:CHA provides quality, affordable, comprehensive health care services at the lowest pos-sible cost for those in need. All patients are 100% below poverty line, 70% are 200% below poverty line. Most are Hispanic.

Additional Comments:CHA wants to add more programs for substance abuse treatment and recovery, but State Medicaid does not allow them to be reimbursed for these services. They’d have to



partner with another organization to qualify for funds. They are trying to get the State to change the reimbursement rules to allow services rendered by MST to be reimbursable.

Department of Veterans Affairs, Addictive Disorders Treatment Program (ADTP)

Contact: Brian Howery — [email protected]

Mission or Purpose:ADTP is a recovery based outpatient program which includes an abstinence based and harm reduction model. The Harm Reduction Model has the goal of helping patients learn how to reduce the risky behaviors and problems or negative consequences associated with addictive behaviors. Harm reduction can include: education about problematic use/behaviors, stopping all problematic use or behaviors, stopping one problematic use or behavior at a time, controlling or limiting one’s problematic use/behavior by reducing its quantity or frequency.

Description:Veterans can start with ADTP in any of the following ways: (1) self-referral by telephone or walk-in visit, (2) referral by medical health care providers, (3) referral by mental health care providers or (4) referral by emergency department or inpatient units. Some Veterans are referred by the court system, particularly Veteran’s Court.

Veterans new to ADTP typically attend an orientation group, which provides an overview of available treatment options and program expectations. Veterans will then be sched-uled for an intake assessment to discuss their goals for treatment and an individualized treatment plan will be created. Any Veteran interested in taking medication to assist in the treatment of addiction will be scheduled for an evaluation with a medical provider. Orientation group is held two days each week. It is a 1-hour class offered by a peer-sup-port specialist. That same day, Veterans are asked if they want to take the next step. If so, an intake date is set. Intake takes approximately 90-120 minutes. A member of the clinical staff will conduct the intake, which will consist of family history, employment history, history of trauma, full social assessment, etc. During the intake, clinical staff will work to identify any co-occurring disorders, understand the patient’s goals and define the treatment program.

In total ADTP has 10 staff members including two nurses, two psychologists, five social workers and a psychiatrist. The program offers 39 groups per week.



A veterans treatment team is typically made up of a psychiatrist, social workers, psy-chologists, nurses, peer support and psychology and social work interns that specialize in the treatment of substance use and behavioral addictions including: alcohol use, drug/illicit substance use, prescription misuse and gambling.

A patient can expect the following continuum of care:

1. Orientation Group

2. Intake Assessment

3. Agreement on Treatment Plan (Typically one of the following)

Option 1: Intensive Outpatient - 7 weeks, 4 hours per day, 3 days per week, random UAs, breathalyzer, IOP case management each week.

Option 2: Outpatient - Every Monday night or choose a couple of groups and days each week; outpatient is an individualized treatment plan to include group participa-tion to meet the veterans needs and schedule during the week.

Option 3: Harm Reduction Model – 5 session course over 5 weeks for Veterans who want to learn how to control risk, want counseling and help addressing other mental health issues.

4. Gambling Track – A 6-week educational class that includes tracking behaviors. Once the class is finished, a monthly support group is offered.

Specific services offered include: outpatient detoxification, medication-assisted treat-ment, intensive outpatient program (IOP), gambling treatment, peer support services, case management, individual psychotherapy, family treatment services, group psycho-therapy including: harm reduction, medication aspects of addiction, relapse prevention, problem gambling, mindfulness, co-occurring disorders and aftercare groups.

The ADTP programs utilize cognitive behavior therapy, an evidence-based approach to changing unhealthy behaviors by focusing on thoughts and feelings. This helps patients to:

1. Learn how certain thoughts and feelings maintain substance use behaviors

2. Learn to identify thoughts about the world and themselves that lead to continued use despite the painful consequences of use

3. Learn to replace these thoughts with more accurate and less distressing thoughts

4. Learn ways to cope with feelings such as anger, guilt and fear that are associated with substance use



ADTP also uses teleconferencing and telehealth to hold groups with Veterans in rural areas that are unable to visit the VA Hospital in Reno.

Population Served:Veterans. In any given month, probably service 200-300 veterans.

Additional Comments:Veterans can receive treatment here on a ongoing basis. There is no limit to services, which is quite unique.

Mr. Howery stated that he finds the VA and this program to be a ‘Cadillac program’. It serves the “Veteran fully in that there is collaboration with many treatment services the VA has to offer”; he feels that they are meeting the veteran’s needs.

The VA does a mental health summit once a year where providers from community can come in and discuss community resources and gaps in treatment resources.

The other assets in the VA that they rely on include the Healthcare for Homeless Vet-erans (HCHV) and the CBOC clinics in the rural communities which provide valuable resources to veterans in the community.


Contact: James Kitchen ([email protected])

Mission or Purpose: James primarily highlighted FCA’s Campus Ministry program, which is initiated and led by student-athletes and coaches on junior high, high school and college campuses. It has four ministry types: Huddles, Team Bible Studies, Chaplain Programs and Coaches Bible Studies. Additionally, outreach events take place on the campus including their One Way 2 Play — Drug Free programs, school assemblies and the annual Fields of Faith event.

Description: Fellowship of Christian Athletes (FCA) currently serves school-aged individuals in the area through its Huddle, One Way 2 Play and Role Model Summit programs. In each school, FCA operates as a student-led club. A Huddle consists of a 30-minute lunchtime meeting in which students come together, do an ice-breaker activity, share a story






or testimony and offer options of hope or a resource. The One Way 2 Play program is school-based assembly prevention program in which professional athletes come to the schools to share their stories of addiction and recovery. James credits their success with the mentorship programs and being present for students in need.

Population Served: Fellowship of Christian Athletes programs are currently in 12 of the 18 area high schools and one area middle school. In total, FCA now has a total of 21 recognized huddles that meet across th Middle schools, High Schools and Colleges in Northern Nevada. The goal is to have these programs in all middle and high schools. At present, James esti-mates that FCA has 50 volunteers and serves approximately 500 students per month not taking into account their assembly programs.

Additional Comments: James noted that his organization is currently understaffed. He also noted seeing mas-sive self-harm and sexual addiction among the students he serves. He attributes the self-harm with low self-esteem caused by student and parent involvement in social networks. He believes kids are harming, particularly cutting themselves, for attention.

Join Together Northern Nevada

Contact: Jennifer DeLett-Snyder ([email protected])

Mission or Purpose:In 1995, a group of concerned citizens started an informal coalition focusing on how to address the growing substance abuse problem in Washoe County. Original conver-sations and plans centered on treatment services and eventually expanded to include prevention. In 1998, the group chose the name Join Together Northern Nevada (JTNN) and incorporated as a nonprofit, 501(c)(3) organization. JTNN brings citizens, agencies, businesses and government together toward the common goal of building a healthy, drug free community. JTNN collects and has access to the latest information on drugs and alcohol, plans and funds substance abuse prevention activities in the community and knows how to find help. JTNN can be thought of as the go-to organization for sub-stance abuse related information.

Description:JTNN is a community coalition that started with a treatment focus but has evolved into



prevention with advent of CADCA. JTNN had a DFC grant for 10 years which ended in 2010. JTNN continues to provide funding to prevention programs through the state’s Strategic Prevention Infrastructure Grant. Annually, JTNN has about $200,000 available for community grant distributions. JTNN develops RFA requirements for these grants with community leader input on RFA criteria every 3 years. Specific to prevention, JTNN extends grants for 8 evidence-based programs that the applicants source from NREP directory.

JTNN serves as a community convener on issues and discussions specific to addiction. Although Reno has prevention resources, it could use more dedicated and consistent resources. A goal for JTNN is to have staff in schools. JTNN looks to build capacity in the community through policy work (i.e. Social Host Ordinance in Reno).

JTNN runs a Parent Support Group (12 active participants, 20-25 in contact with) and an inactive Chronic Pain Group. JTNN also does a considerable amount of outreach trainings including in-service days for school counselors, awareness and education and peer-to-peer approaches. At the time of our meeting, JTNN was running a PSA contest in schools.

JTNN mentioned having relationships with the following organizations:

1. Quest Counseling and Consulting

2. Municipal courts

3. Law enforcement

4. Juvenile justice

5. Washoe County School District

6. Social services

7. Substance Abuse Line through the Crisis Call Center (775) 825-HELP

Population Served:Northern Nevada



Life Changes, Inc.

Contact: Lisa Moore ([email protected])

Mission or Purpose:Life Changes, Inc. is a sober living program providing women in recovery with structured living with two residential housing facilities in the Reno-Sparks area.

Description:In total, Life Changes, Inc. currently has a total of 25 transitional housing beds.

When a woman first arrives at Life Changes, staff completes an intake interview with them. Then, based on the intake, they create a plan. Clients can stay as long as they want; many people stay a year or more. However, when they first arrive, since many are court mandated and referred from the drug court, people have varying degrees of inter-est in joining Life Changes.

During the first two weeks as a resident; women are required to find a job. Once they are able secure a job, they are expected to pay rent at a rate of $150/week. Each location has a house mom who helps to oversee the programming. All residents have to be in house by 6pm. 12-Step programming is an important part of Life Changes; all residents are required to find a sponsor. If additional services are needed to support an individ-ual’s recovery plan, Life Changes works to connect residents to appropriate additional services and trys to negotiate no fees for services. At the time of our interview, their residents were finding jobs at Family Dollar and FedEx.

Population Served:Women over 18 years old.




Nevada State Office of Rural Health

Contact: Gerald Ackerman ([email protected])

Mission or Purpose:The Nevada State Office of Rural Health was created by the state legislature in 1977 with a mission to assist rural communities. The Office provides a broad array of technical assistance activities across all counties in Nevada. Annually, the program has continu-ous contact with over fifty communities and provides services such as education and training, outreach, hospital and health professional technical assistance, EMS technical assistance, telehealth/telecommunications, policy development/analysis and healthy workforce activities. The office is dedicated to improving the health of rural Nevadans and serves as a focal point for a variety of programs. The Office of Rural Health provides state and national leadership in addressing recruitment and retention issues, technology resources and promotion of graduate medical education. Key functions of the office are to provide coordination and technical assistance for rural Nevadans seeking health re-sources, conducting community development activities and advocating for rural health issues.

Description:There are 4 programs run out of the Nevada State Office of Rural Health that contribute to the prevention, treatment and recovery continuums in Northern Nevada.

They include:1. Area Health Education Centers (AHEC): AHEC was established by the Nevada

Legislature in 1987 and provided additional authorization in 2003. Nevada Area Health Education Centers have offices in Reno, Las Vegas and Elko to provide services statewide to all Nevada counties. The AHEC program mission is con-sistent with a national network of programs to enhance access to quality health care, particularly primary and preventive care, by improving the supply and dis-tribution of health care professionals through community/academic educational partnerships. AHEC reaches out to rural and urban areas with shortages of health care professionals. Continuing education classes, information services, student programs, library services and innovations in distant linkages provide enhanced practice opportunities for health practitioners in Nevada.

2. The Office of Rural Health looks at policies and delivery of services throughout Nevada. They used to run a loan program that encouraged healthcare profession-als to go to rural areas; however, this program is no longer offered.




3. Nevada AIDS Education Training Center (NAETC): NAETC is part of a federally funded nationwide network of programs whose mission is to provide up-to-date scientific and clinical care information and education to health professionals. AETC conducts targeted, multidisciplinary education and training programs for health care providers treating people living with HIV/AIDS. The Nevada AETC serves as a resource to health professionals statewide, linking them with HIV specialists and assisting them in accessing the most current information in order to prepare them to provide high quality, compassionate care to their patients with HIV. The funding for this program has been cut over time but they used to run programs for addiction, Hepatitis, clean needles, HIV and more.

4. Project ECHO: The goal of Project ECHO is to meet the needs of primary care providers by offering an alternative to costly travel and long waits for patients who need specialty care. By developing the knowledge base of primary care providers through innovative telehealth consultations offered by Project ECHO, patients in rural and under-served areas benefit from specialty care becoming available local-ly, and without the cost and time of accessing specialists directly. Project ECHO is getting ready to implement a pain management clinic; the clinic will be offered out of the School of Medicine at UNR and will offer telemedicine to the rural coun-ties. Evan Klass directs the project. Project ECHO Nevada consists of clinics in the areas of: Diabetes/General Endocrine, Antibiotic Stewardship, Hepatitis-C, Sports Medicine, Gastroenterology and Rheumatology.

The programs are disseminated through personal contact, dealing mostly with rural pro-viders, rural hospitals and rural clinics. For the past 2-3 years, the emphasis of this office has been primary care issues.

Population Served:The Nevada State Office of Rural Health serves rural Nevada populations. The greatest struggle in rural Northern Nevada in regards to prevention, treatment and recovery is the absence of qualified workforce. The rural areas need clinical social workers and ad-diction specialists. At present, there is a shortage and they find it hard to entice these professionals to live in such rural locations.

Additional Comments:In rural, northern Nevada, distance is a huge barrier. Most people struggling with addic-tion end up in hospital or primary care clinic. Therefore, in these rural areas, efforts to educate these providers are increasingly important.

Historically, the Nevada State Office of Rural Health was heavily involved in passing the legislation that allowed for drug and addiction counselors to be able to offer services via telemedicine. Following the passing of legislation, they developed a video system to rural clinics and hospitals for education and direct services through telemedicine.



Other organizations that the Nevada State Office of Rural Health coordinates with in-clude: Nevada Rural Hospital Partners, Nevada Health Centers (they run 24 clinics around the state), the different tribal organizations, programs of the state health division and the Department of Veterans Affairs.

At present, prevention is the biggest funding focus in rural NV. There is a huge problem with methamphetamines and prescription drug abuse. The mining communities have enough money and parents can be gone for long periods; this exacerbates the problem for youth.

Mr. Ackerman indicated that the Rural Hospital Association and Nevada Health Centers are working well and that both recently received grants to look at mental health and co-occurring disorders. He is also seeing behavioral health services being integrated into ER and other primary care visits. In his opinion, the biggest barriers to care in north-ern Nevada are availability of professional workforce to diagnose, treat and support addiction and recovery as well as a lack of infrastructure.

Mr. Ackerman mentioned the treatment programs offered at New Frontiers in Fallon and Vitality Center in Elko indicating both seemed to be offering good services.

Lastly, he discussed the state rural clinics that function as the mental health system for rural counties. These small clinics scattered throughout the state are staffed by clinical social workers, marriage and family therapists and psychologists and support patients with co-occurring disorders. These are currently run by Kathryn Baughman. Nevada is one of three states in the United States that operates the public behavioral health sys-tem for its vulnerable residents. In 2013, the Mental Health and Developmental Services Division merged with the State Health Division to become the Division of Public and Behavioral Health (DPBH). As a result, behavioral health services throughout the State of Nevada are undergoing significant change.

The most significant primary provider for public behavioral health services is DPBH. Within the Division, there are four service delivery systems (two of which are applica-ble to Northern Nevada) operated to protect, promote and improve the physical and behavioral health of the people in Nevada. These systems include Northern Nevada Adult Mental Health Services (NNAMHS) and Rural Counseling and Supportive Services (RCSS).

• NNAMHS is located in Sparks, Nevada, and is a comprehensive, communi-ty-based, behavioral health system for adult consumers. Inpatient services are provided through Dini-Townsend psychiatric hospital, located on the same campus as the central NNAMHS site. Numerous outpatient services are available which include the Washoe Community Mental Health Center, Outpatient Phar-macy, Program of Assertive Community Treatment (PACT), Psychosocial Reha-bilitation Program (PRP), Consumer Peer Counseling and Service Coordinator Services.



• RCSS has seven full service clinics, five partial service clinics and one limited ser-vice clinic that provide behavioral health services to both adults and children in the rural areas of the state considered to be every county with the exception of Washoe County, Clark County, Lincoln County and parts of Nye County. Satellite clinics provide all services offered by RCSS. Sub-satellite clinics offer many of the same services with itinerant clinics providing services less frequently. RCSS is the only service system within DPBH to provide services to children and adolescents.


Contact: Monica DuPea ([email protected])

Mission or Purpose:Nevada Youth Empowerment Project is a 100% community funded independent living program for youth with a willful attitude who are physically, mentally and emotionally capable of completing the program components. The purpose is to provide a residential life program to transitioning youth facing poverty and homelessness.

Description:NYEP runs two programs: (1) a community living program (CLP) and (2) an affordable housing program offering housing at $300/month.

The core purpose of NYEP’s CLP is to assist homeless older teens in becoming indepen-dent, self-sufficient community contributors. The CLP is a supportive transitional housing program for older youth, based out of an 8 bedroom, 6 bathroom home located near UNR. The nearest bus line is less than 3 blocks away from the house. It is capable of housing up to 15 residents. There is a common (living) room, clothing closet, computer area, laundry room, art room and office within the home, giving residents handy access to staff members. The CLP comprises of a 12-18 month stay in the house. The CLP is staffed 7 days a week from 7:30am-9:00pm. There is no staff at the house at night – if there is a problem, residents will text Monica and she will handle the issue the following day. Each resident is provided with a bedroom; they may share their room with another resident. They are also provided with food, daily living supplies, case management, self-sufficiency training and parental support through daily professional, adult guidance.

The house has a deadbolt lock with keypad entry. New residents have a 6pm curfew. However, after 30 days in the program, residents are eligible for a later curfew. The initial curfew is intended to help NYEP build buy-in to the program. Having residents home by



6pm allows them to participate in scheduled evening activities and spend time with staff and other residents to build new relationships.

The residents must use a sign-in/out log, located by the front door, whenever they leave the facility. This lets staff know their whereabouts at all times, as well as instilling in them a sense of accountability. The house is hard wired with fire alarms and equipped with a fire plan. An exit strategy, in case of emergency, is posted in two hallways within the house. A fire drill is rehearsed monthly.

NYEP also has a civic engagement and an employment series that is delivered to each CLP resident. The series includes making contact with an opportunity, writing a resume, understanding a job description and expectations, job searching, interview role playing and receiving supervisor feedback. NYEP also assists resident students in identifying and acquiring college funds.

When a new community member first arrives they are expected to complete their chores (there is a chore rotation schedule), adhere to a calendar and go to school, work or vol-unteer. The mid-term outcomes are saving money and getting a job. In the long-term the goal is for each individual to keep a job and build up stamina to function at the 40-hour per week schedule. In order to achieve this outcome, bank statements are collect-ed each week, individuals cook meals and complete cost reconciliation.

Since the criteria for acceptance is only ‘willing’ and ‘capable’, often individuals are not motivated. NYEP uses a token system so that as the youth learn their likes, the program uses those as incentives to motivate specific actions/tasks. Generally, once a youth sees/feels the goodness and reward of their effort, they are motivated to give more. Tokens can be used to pay cell phone bills or to get beauty services, amongst other things.

NYEP has found it is critical to be consistent, accountable and to offer praise. To do this, they must be properly staffed and resourced to be an effective program producing de-sired youth outcomes.

When someone is interested in joining NYEP, they are invited over for a tour and an in-person interview. They are asked why they want to move in and if they know about the curfew. If agreeable and space is available, they are asked to review and sign the program agreement that functions as a contract.

Additionally, a mentor program is a key component to the program. The mentoring rela-tionship is typically between board members and youth. As new kids move in, there is a need to develop a mentor pool. Not all board members mentor; however, people who do mentor are more connected to the program. As NYEP develops the pool of mentors, many are friends of board members.



Population Served:NYEP has served approximately 100 homeless girls since it opened. Typically, individu-als are 18-21 years old; however, sometimes exceptions are made. The current facility serves 15 residents.

Additional Comments:NYEP offers alumni programming on holidays including Christmas and Thanksgiving and through group volunteer events. Other facilities in Reno similar to NYEP include: Eagle Valley and Life Changes.


Contact: Sharon Chamberlain ([email protected])

Mission or Purpose:Northern Nevada HOPES was originally founded in 1997. Initially, they provided med-ical care for people with HIV, had case management and a pharmacy. Today, they are dedicated to building a healthier community by providing coordinated care and sup-port for individual and family wellness. Their community health center combines primary care, medical specialties, behavioral health and prevention with a team of experienced professionals who are committed to high-quality care. With the passing of the Afford-able Care Act and Medicaid expansion in Nevada, Northern Nevada HOPES decided to move toward becoming a Federal Qualified Health Center. Northern Nevada HOPES became a FQHC is November 2013. This certification allowed them to expand into pri-mary care. The vast majority of patients have a mental health or co-occurring disorder and are on Medicaid or are uninsured.

Description:When someone first wants to access the services at Northern Nevada HOPES they should call for an appointment. If uninsured, an individual will pay for services based on FPL. The SFS slides down to $10 for medical and $2 for behavioral health. Northern Nevada HOPES functions on an open access appointment system - from 8am-8:15am each morning individuals can call and make appointments. It is first come first served. This system allows them to take care of the immediate needs of their patients. Patients can expect to see an MD, NP, or a PA on initial intake assessment. Currently, they are working to incorporate a behavioral health consultant into each new visit. Recently, for counseling, they have shifted to a client centered, goal directed treatment plan. They



have been using a behavioral health consultant part-time in the clinic setting but now they are working to use a consultant do screening for substance use and depression to get a solid read on whether a particular patient may need more long term therapy or a brief focused intervention.

For medically underserved populations such as the LGBTQI community, drug users, sex workers, the homeless and those living in poverty, HOPES functions as a one-stop-shop healthcare model reducing barriers to care and increasing the likelihood of maintaining long-term health for its patients. HOPES accepts most insurance plans, including Med-icaid, Medicare, and for the uninsured offers discounted services on a sliding fee scale.

Upon arrival, a patient can expect the following continuum of care:

1. Intake and assessment

2. If interested in counseling, they can discuss symptoms and if the patient wants relief from symptoms then they are referred to the behavioral health specialty clinic to de-velop a treatment plan. In the specialty clinic there is a more extensive assessment. The assessment and treatment plan is discussed with the patient and treatment stays specific to goals presented by client and indicated as part of the treatment.

3. Patients are welcome to return at any time should additional matters come up.

Northern Nevada HOPES is currently in the process of greatly expanding their facility; the new facility, expected to open in December 2015, will include a family wing. The new building will allow them to serve a larger cross-section of the population. The hope is that their services will no longer be about just healthcare - the vision for HOPES is that they will become a true community health center. The intention and vision is not to have lateral growth and expansion throughout Northern Nevada. The goal is grow roots deeper and deeper so HOPES belongs to the community and is a place for birthday parties for kids, basketball out back and kids doing homework. They feel that in the new building the sense of community will really help people to get better.

Currently Northern Nevada HOPES is using a harm reduction approach in addition to a seven dimension wellness model. They offer medical, behavioral health, social, phar-macy and transportation services in addition to care coordination and health education. Northern Nevada HOPES is legally obligated to respond to needs in terms of self-harm or homicidal behavior. The goal of the care team is to create choices for their patients. Currently, they are trying to get all staff trained in trauma informed care – this includes an awareness that any and all senses are considered for the patient - because a color or smell in the environment could trigger the trauma; they are using outside consultants to train teams on this. The goal is try and provide services and programs most beneficial to the community.

Northern Nevada HOPES just started a recuperative care program for people who are



not sick enough to stay in the hospital but too sick to be released to the street; they have hotel rooms that qualified patients can move into where a Community Health worker checks with them daily to make sure they are on track to get care.

Population Served:Currently, Northern Nevada HOPES services approximately 150 new patients each month. Currently, they are serving over 3000 patients. Approximately 80% of the popu-lation served has some sort of PTSD and 25% are homeless.

Additional Comments:Northern Nevada HOPES partners with the Mobile Outreach Team, West Hills and West-Care. The Northern Nevada HOPES outreach team goes to several of the area’s sub-stance abuse recovery programs providing TB, HIV and Hep C testing.


Contact: Joann Flanagan ([email protected])

Mission or Purpose:The Reno Sparks Tribal Health Center (RSTHC) is a tribally-owned and operated clinic, lo-cated on the Reno Colony at 1715 Kuenzli Street. The health center is committed to en-hancing the quality of life of all of American Indians by providing a culturally competent and patient-centered continuum of care. The mission of the Reno Sparks Tribal Health Center is to raise the physical, mental, social and spiritual health of American Indians and Alaska Natives to the highest level. Under the provisions of a Title V Self-Gover-nance Compact, The Reno-Sparks Indian Colony Title V Compact with the Indian Health Service allows the Reno Sparks Indian Colony to administer individual programs and services the IHS would otherwise provide. The Reno Sparks Tribal Health Center runs a Substance Abuse Program.

Description:The clinic has a section dedicated to behavioral health (mental health and substance abuse). The substance abuse program is staffed by four state licensed alcohol and sub-stance abuse counselors. These counselors provide ASAM 0.5, I and II.5 levels (intensive outpatient treatment or IOP) of care. ASAM Level III service is not available in-house and clients requiring these services are referred out to I.H.S. or I.H.S. contracted programs. Detox services are not available and referred out to local detox centers.



I.H.S. through RSTHC funds adult and adolescent inpatient treatment (ASAM Level III) programs at offsite facilities. Typically, it takes about a month to get a patient into an inpatient program. While they are awaiting an inpatient treatment bed, patients partici-pate in the IOP; no one is turned away for inpatient treatment. However, they may have to wait. There are no time limitations to outpatient services; treatment plans may expire and a new treatment plan would need to be developed in order for someone to contin-ue to access services.

Inpatient services for adults are typically provided out of state at Guiding Star Lodge in Phoenix, AZ, which serves women over 18 and their children and transgender popula-tions for 45 days, and for men the Native American Connections also located in Phoenix which serves men over 18 for 45 days.

For youth, inpatient treatment is typically provided at Nevada Skis Youth Wellness Cen-ter in Wadsworth, Nevada and Desert Visions Youth Center in Sacaton, Arizona which serves 12-18 year olds for 120 days. All of these locations provide culturally competent care. Other Indian

Health Service/Tribal Youth Residential Treatment Centers that are utilized by their program include:

1. Healing Lodge of the Seven Nations in Spokane, WA which serves 13-17 year olds for 60-90 days.

2. New Directions – Four Winds Turning & Serene Life in Tucson, AZ which serves men and women over 18 for 45 days.

3. Renaissance House in Tucson, AZ which serves women over 18 and their children for 45 days.

4. The Haven in Tucson, AZ which serves women and their children and men over 18 years of age for 45 days.

5. Native American Rehabilitation Association in Portland, OR which serves women over 18 and their children and men over 18 for 45 days.

6. New Frontier Treatment Center located In Fallon, NV which serves men and women over 18 for 45 days.

7. Whiteside Manor in Riverside, CA which serves men and women over 18 for 45 days.

Each potential client completes substance abuse evaluations and if there is a need for mental health evaluations, they are referred to a in-house psychiatrist or psychologist to



obtain a mental health evaluation. The program receives referrals from the court system and by word of mouth. They also provide substances abuse education. They have a designated prevention coordinator. He conducts outreach with youth and prevention education with youth and teenagers. He encourages wellness and conducts suicide pre-vention. I.H.S. provides funds to conduct suicide prevention for the tribe.

Other services provided are:

1. Two support groups meetings per week

2. Group counseling

3. Encourage attendance at 12-step outside of facility

4. Sweat lodges for healing and cleansing

5. Tribal church - Reno Sparks Christian Fellowship

Joann indicated that they utilize The White Bison - Mending the Sacred Circle, an evi-dence-based program approved by SAMHSA for their prevention curriculum. The pro-gram offers spiritual ceremonies and arts and crafts as part of the recovery activities. The recovery work focuses on mental, physical, spiritual healing. A Native American belief is re-establishing spirituality first is key to recovery. They also use cognitive behavioral therapy. The clinical models are evidence-based practices and curriculums, which are tai-lored for the Native American culture. The majority of their clients are mandated through court, social services or other entities.

The Affordable Care Act (ACA) has impacted the American Indian/Alaska Native in posi-tive manner, in that those clients who qualify for Medicaid can access health care outside I.H.S. and tribal health care facility can bill Medicaid for services.

Population Served:American Indian/Alaska Natives who are members or descendents of a Federally Rec-ognized Tribe.

Additional Comments:Joann provided contacts for two other organizations she thought may be considered resources. They included two inpatient referral programs that are Indian Health Service (I.H.S.) approved/contract, Native American specific, non-profit inpatient treatment pro-grams.

Leslie Steve, MA, LADC Mental Health/Substance Abuse Project Director



Fallon Tribal Health Center 1001 Rio Vista Fallon, NV 89406 (775) 423-3634, ext. 225 FAX: (775) 423-0621 www.fpst.org

Vickie Lillegard Nevada Urban Indian, Inc. [email protected] (775) 788-7600

Ridge House

Contact: Steve Burt ([email protected])

Mission or Purpose: Ridge House provides outpatient and residential mental health, substance abuse and co-occurring treatment as well as transitional living for individuals who are criminal jus-tice involved. Ridge House provides comprehensive case management, counseling and workforce services for this group. The mission of the Ridge House is to restore lives in our community by fostering law abiding citizens through compassionate services.

Description:Ridge House was founded in 1982 by a group of ecumenical prison ministries programs and was later incorporated as a 501 (c) 3 non-profit organization. The first location of Ridge House was a rented a house on Ridge St. in downtown Reno. Over time, the or-ganization has grown to 41 beds across six properties and an office building where case management, outpatient treatment and workforce services are delivered.

Through the Ridge House transitional living facilities, the organization re-creates a fami-ly-based environment limiting populations to 6-9 beds per property. Among the organi-zation’s houses, one is dedicated to serve women with six beds and another specifically for formerly incarcerated Veterans. Ridge House utilizes peer-support specialists who have been through the criminal justice system as well as a substance abuse counselor providing treatment for clients at each house. The Ridge House outpatient facility and workforce development programs serve over 350 individuals per year. Ridge House is funded through a substance abuse federal block grant and is fully credentialed as a

http://www.fpst.org/

mailto:VLillegard%40nevadaurbanindians.org?subject=






Medicaid provider and can also accept all of the region’s major health insurance plans, including Amerigroup, Health Plan of Nevada and Anthem.

For the transitional living services, the average length of stay for men is 70 days; for women 85-92 days; and for Veterans 120 days. In 2013, Ridge House provided services for 312 individuals to successfully reintegrate into society. Ridge House clients return to the criminal justice system only 25% of the time in three years as compared to national recidivism statistics in which 67% of former offenders return within 3 years. Clients report a satisfaction rate of 97%.

The comprehensive programming for clients is intended to assist the individual in their journey toward becoming tax paying, law-abiding, productive citizens. Some of the ser-vices Ridge House provides include:

1. Employment Services: Resume and job skills development courses, education and vocational training, interview workshops and job placement services;

2. Re-Entry Services: Case management, life skills counseling, credit restoration, voter registration, self-help support groups, mentoring and peer services; and

3. Treatment Services: Behavioral health counseling, substance abuse counseling, men-tal counseling, one-on-one counseling, group counseling.

Outpatient and residential clients are also taught basic living and workforce retention skills in addition to receiving evidence based therapy services which include motivation-al interviewing, cognitive behavioral therapy and the Matrix Model. Ridge House also integrates a combination of 12-step and peer-to-peer services to support the recovery of their clients.

Upon arrival at the Ridge House staff ensures individuals obtain items to meet basic needs such as clothing, person hygiene products and documentation for employment and health insurance enrollment.

Through participation in the Ridge House programming clients are encouraged to:

1. Maintain sobriety;

2. Get involved in a self-help recovery community;

3. Participate in the workforce development program in order to

a) Acquire employment;

b) Maintain said employment;

c) Acquire vocational training.

4. Prepare for and move into a residence of their own.



When clients move out of transitional living services, they participate in the outpatient program until the individuals’ unique set of goals have been achieved.

Upon discharge, clients are transitioned to the outpatient program and Ridge House continues follow-ups for one year. This is a result of the workforce grant that requires clients to be on parole for at least one year in order to be served by Ridge House.

Population Served: Ridge House provides treatment services for emerging adults ages 18 and above in-volved in the criminal justice system. Ridge House is fully credentialed and certified to work with clients who present with a substance use, mental health, or co-occurring disorder. Ridge House seeks to reduce barriers for clients who wish to live a crime and substance free life.

Step 1, Inc.

Contact: Dani Doehring ([email protected])

Mission or Purpose: Step 1 contributes to the safety of the community by providing a clean and sober struc-tured living environment with counseling for individuals suffering from addictive and mental health disorders. Clients are returned to the community as self-sufficient, respon-sible fathers, individuals and citizens.

Description: Step 1 is an adult men’s transitional living facility with outpatient substance abuse coun-seling. Step 1 has been in the community since 1993. They have a total of 20 beds for adult males. Step 1 is certified by SAPTA as a Transitional Living Facility and licensed by the State of Nevada as a Facility for the Treatment of Alcohol and Drugs. Along with Transitional Housing, Step 1 provides Level 1 outpatient substance abuse counseling and collaborates with other community agencies to provide medical, psychiatric and vo-cational services. Step 1 is run by five full-time and two part-time employees. Step 1 is a Medicaid and Amerigroup provider (meaning they accept those two types of insurance).

Step 1 receives referrals from homeless shelters, hospitals, prisons, jails, Northern Ne-vada Adult Mental Health, detox and inpatient treatment centers, family members, 12-Step community members and out of state individuals who find Step 1 on the internet. Some people come directly from an inpatient treatment center or detox. In other cases,



they come directly from jail, prison or mental health facilities.

When a client first comes to Step 1 they will experience the feeling of safety and being home. The continuum of care begins with basic needs. Food, shelter, clothing and hy-giene are the first concerns. Then they move on to the basic structure including getting up on time, daily chores and job searching until employment is secured. Counseling also begins during the first week. Any outside services such as medical, dental, psychiatric and gambling addiction are also set up in the first two weeks.

A typical schedule for the first two-days at Step 1 may look like the following:

Day 1

1. Reassure the client they are in a safe place

2. Take care of their basic needs - food, clothes, shower

3. Complete an intake at transitional facility

4. Meet with the outpatient counselor for intake

5. Schedule TB testing (conducted by Northern Nevada HOPES)

6. Get the client settled in a bedroom and review the rules

7. Ensure client checks in this his parole officer

Day 2

1. Begin job search (Requirement is to complete 10 applications per day 8am-5pm)

Step 1 uses a sliding fee scale for rent. Clients pay $70-$140 per week. Counseling costs are generally covered by Medicaid or Amerigroup. If a client is not eligible for insurance, a sliding fee scale is administered - Minimum fee is: $7.96 for group session and $18.48 for a one on one session.

Other services include: Low-income housing, food, certified substance abuse counsel-ing, laundry facilities, personal mentors, peer support groups, educational groups, life skills and employment preparation.

On first contact someone should expect to be treated with kindness, compassion and be given the information on how to apply for services. Prior to arriving, potential clients must complete a 5-page application. Step 1 scores the applications. People with sex offenses or multiple violent offenses will not be admitted. Clients must have a minimum of 72 hours sober when they arrive at the facility. Step 1 reviews the application, and if it



meets the appropriate score, a bed date will be set. The minimum stay is 90 days.

During the winter months the wait list is often 2-3 months. During the summer months, there often is admission within a couple of days to one week.

Step 1 utilizes cognitive-behavioral therapy, motivational interviewing and a 12-step pro-gram to help support clients on their recovery journey. Outpatient counseling is conve-niently located right next door to the Step 1 location. 12-step meetings are held onsite twice per week.

The philosophy of Step 1 is ‘Do the next right thing, even when no one is watching’.

The goal after a person leaves Step 1 is independent living. While residing at Step 1, clients are encourage to save money to obtain an apartment and continue working and living in the community. On the 90th day, people are supposed to be able to move out.

Population Served:Step 1 has served over 3500 adult men. From 2012 to 2014 a total of 235 men were served at Step 1. In 2013, the recidivism rate was 91% meaning only 9% of clients treat-ed at Step 1 returned to prison in the critical first year period after leaving the program.

Additional Comments:According to Dani, there are not enough halfway houses or transitional living facilities in Reno. There always seem to be a wait lists.

STEP2

Contact: Diaz Dixon ([email protected]) and Mari Hutchinson ([email protected])

Mission or Purpose:STEP2 is a private, non-profit 501(c)(3) agency located in Reno, Nevada. STEP2 has been serving Northern Nevada since 1986 with a mission to provide comprehensive, coordi-nated services related to the treatment and recovery of chemically dependent women and their families, resulting in sustainable self-sufficiency.

Description:STEP2 pioneered gender-specific addiction treatment in Nevada, providing state-of-the-art care for women overcoming substance abuse. The agency operates over half of the services in the entire state designed specifically for pregnant and parenting women.




STEP2 provides care in residential, intensive outpatient and outpatient settings. Women receive evidence-based substance abuse treatment interventions combined with the following comprehensive services, in order to provide a holistic approach to increased health, family stability, self-sufficiency and improved quality of life:

1. Transitional housing2. Trauma-informed care3. Domestic violence advocacy4. Intensive case management5. Parenting skills development6. Nutrition education7. Employment readiness8. Subsidized childcare9. Couples and family therapy

10. Transportation assistance

On first arrival, a client may come in for legal services or domestic abuse support, in which case they are referred out to organizations who can better meet their needs. If substance abuse is identified as the primary issue, they will receive services through STEP2. The first step is assessment, which includes a survey to uncover trauma. Then, the client meets with counselor to determine level of programming. All clients must test clean (sober) upon assessment; if they do not they are sent to WestCare for detox. Upon admission, all clients are assigned a big sister/mentor. Following a successful intake, most individuals are added to a wait list. At the time of our interview, the wait list was about one week. At STEP2, their program services coordinator acts as a case manager.

Initially, the level of care needed is determined. As it stands, most potential clients are assessed as needing residential care.

The levels of care offered at STEP2 include the following:

Outpatient Services (Level 1)

Designed to treat the consumer’s assessed level of illness severity and to achieve perma-nent changes in a consumer’s substance using behavior. This service is provided in fewer than 9 contact hours per week.

Intensive Outpatient Treatment (Level 2.1)

Needs for psychiatric and medical services are addressed through consultation and re-ferral arrangements. This service is provided in 9 or more hours of structured counseling and education services per week.



Clinically-Managed Medium-Intensity Residential Service (Level 3)

Consumers enter this level of service when the effects of addition on the individual’s life are so significant and the level of addition-related impairment is so great that outpatient strategies alone would not be feasible or effective. Programming and staffing address more severe medical, emotional, cognitive and behavioral problems. Case management provides a “wrap-around” service.

In total STEP2 offers the following housing options:

1. 16 bed residential facility off-site (Cornado) that has a 3-5 month average stay.

2. 25 fully furnished cottages (Lighthouse cottages) that have a 9-12 month average stay. Clients and their families get to take all furnishings from the Lighthouse cottag-es with them when they leave and the first month is free.

In addition to these residential and IOP services, STEP2 services 35-50 women in outpa-tient services at any given time. If a client has a safe place to stay they return home then continue outpatient services with STEP2. Graduates of the program are always welcome to come to ‘continuing care’ sessions.

Throughout their programming, STEP2 uses cognitive behavior therapy, dialectical be-havior therapy and motivational interviewing.

STEP2 receives referrals from the following organizations:

1. Private treatment centers

2. Jail – STEP2 does assessments at the jail every week

3. Court System

4. Child Protective Services

STEP2 coordinates its efforts with the following organizations:

1. Renown pregnancy center for education and family care

2. Foodbank of Northern Nevada subsidizes food for residential programs

3. Refers women to Northern Nevada HOPES for medical care and sexual disease test-ing; Northern Nevada HOPES does TB testing at STEP 2 every Tuesday and Thursday

4. Refers those who need detox to WestCare

5. Northern Nevada Adult Mental Health Services provides medicine

6. The Children’s Cabinet subsidizes child care (90-100%) for women who find work



7. The Boys and Girls Club provides one year free membership, assistance with fund-raisers and access to vans

8. Washoe County Legal Services

9. Committee to Aid Abused Women

10. Safe Embrace

11. Advocates to End Domestic Violence

12. American Red Cross teaches monthly group session

13. Wells Fargo teaches financial literacy session

14. UNR provides interns

All services are available on a sliding fee scale and no woman is refused care due to her ability to pay for services.

Population Served:Since its inception, STEP2 has served over 3000 women and their children primarily throughout Nevada. STEP2 serves an average of 170 women and families per year. Preg-nant women and women struggling to overcome IV drug-use receive priority placement. Although STEP2 specializes in working with families to end the cycle of addiction, wom-en without children are also welcome in STEP2’s programming. Women must be 18 years or older. 90% of the women served are single moms.

Additional Comments:If someone’s mental health issue is primary over their substance abuse issue then they should not come to STEP2.

There is not a correlation between the success rate of self-referrals (vs court ordered or CPS mandated treatment).

UNR – NRAP and CASAT

Contact: Daniel Fred ([email protected]) and Meri Shadley ([email protected])

Mission or Purpose:There are three programs that exist on the UNR campus: NRAP, NRAP Pack and CASAT.



NRAP provides an environment of nurturing support and peer connections for students recovering from substance and behavioral addictions and students choosing a sub-stance-free lifestyle. Students who want to live a sober lifestyle tend to isolate and have a difficult time connecting with other students. NRAP was developed to provide a safe and fun community where students can meet others and not feel alone. Through their on-campus center students can drop in between classes, study, attend meetings, play video games, and most of all, make new friends. Recovering and sober living students challenge today’s perceived norms of substance use on college campuses. To support them, NRAP houses recovery and wellness meetings, provides opportunities to give back to others and their community, focuses on academic success and allows students to grow in their mind, body and spirit. Students living a substance free lifestyle have the opportunity to celebrate each day and not have the past define their future. NRAP focuses on overall wellness with a goal of supporting students to find acceptance, hap-piness, fun, peace, success and commitment to a healthy life. Connecting with others and growing individually allows our students to thrive during their college experience.

NRAP Pack is a UNR sanctioned student club which is managed totally by the students of NRAP. They support the sober lifestyle through sponsoring alcohol/drug free events such as concerts and outdoor adventures, providing support and after hours activities for interested students, and managing service projects.

CASAT (Center for the Application of Substance Abuse Technologies) exists to help states, organizations, students and the existing workforce apply research-based practic-es to improve prevention, treatment and recovery services for individuals with addictive behaviors. This mission is achieved through university-based coursework; clearinghouses and libraries; continuing education workshops; product development and dissemination; conferences; and consultation and technical assistance activities. Since 1993, CASAT has provided culturally appropriate, state-of-the-art, research-based training and technology transfer activities, academic courses, and managed large multi-state, multi-organization-al projects. Of particular note is CASAT’s familiarity with successful technology transfer strategies housing state and federally-funded training and technical assistance projects that bridge the gap between science and practice. An example of these projects include workforce development training for Peer Recovery Support Specialists, curriculum for the healthcare workforce related to Fetal Alcohol Spectrum Disorders, and a national center for the development of telehealth innovations. In addition, CASAT’s academic efforts include coursework for both undergraduate and graduate programs for students in addiction prevention and treatment services. One of the themes Daniel and Meri talk about is ‘re-framing addiction’, which they do in part by confronting beliefs about certain drugs....and in part by demonstrating that most people know someone who is a user, who has overdosed or who is in recovery.

Description:The prevention program at CASAT provides technical assistance and training in outside communities for general prevention. This keeps the university programs connected to



and contributing to the broader community. Additionally, their Sober and Healthy Living Coalition on campus brings together multiple departments and community organiza-tions to address the stigma of addiction by jointly supporting recovery and wellness activities and by changing the perceived norms of college substance use. This group currently has over 70 members.

N-RAP, their core Collegiate Recovery Program on campus is a bit different than oth-er CRPs in that they welcome members not in recovery but who want to live a sober lifestyle. On campus N-RAP has 3-4 meetings each day, from AA to Nicotine support to meditation to body image to wellness. CASAT is viewed as N-RAP’s greatest asset. It brings the college community into the recovery community on campus. Part of this through the intro to addiction class that Daniel teaches. This course brings together nursing, criminal justice, social workers, psychology workers and some biology / neuro-science majors. N-RAP has become the face of CASAT on campus; their members go out into sororities and fraternities, for example, and share stories at conferences.

For students in CASAT or who are members of N-RAP, Daniel and Meri help them to find internships, which also brings them into the community.

CASAT is allied with UNR Division of Health Sciences, Problem Gambling Prevention Project, Nevada Works, Addiction Technology Transfer Center Network (ATTC) and Mountain Plains FASD.

They also sponsor a student organization, N-RAP Pack, which has taken ownership of prevention on campus. They are making themselves visible putting together prescrip-tion pill awareness programs.

N-RAP participates in the Nevada Peer Advisory Council and is close with Quest Coun-seling, the Center for Hope (eating disorders) and other private practices.

Population Served:N-RAP, N-RAP Pack and CASAT serve college students in recovery, college students interested in living a sober lifestyle, college students studying the substance use and addiction field. N-RAP currently has 62 applications for members of the collegiate re-covery community. CASAT also serves the broader Reno community. CASAT’s Addiction Treatment Services has now been a minor at UNR for 20 years and is the largest minor on campus. They have 900 people taking their courses every year.

Additional Comments:N-RAP has been working with Truckee Meadows Community College to start a colle-giate recovery program but it has been growing more slowly than originally desired due to institutional barriers. For example, most students want to meet after 5pm but their N-RAP location is considered a community center that closes at 5pm. They feel it is still a worthwhile endeavor as TMCC is a feeder to UNR. Historically, a lot of N-RAP’s students come from TMCC, so this seems like an important feeder. TMCC is oftentimes a student



in recovery’s first reentry back into education. They’ll get their associates degree there then go to UNR where they will need the support of a recovery community.

When asked what is working for them, Daniel and Meri cited N-RAP’s location in the center of campus. They said people stop by during their day and that the drop-in piece is a critical piece of any CRP. They don’t think that students are looking for meetings as they can find those off-campus. They are looking for connection, understanding and acceptance.

Currently, their biggest need is for a safe place for their students outside of the 8am-5pm timeframe. This is a bigger need than recovery housing. There are not any dry places for students to hang-out. They’re not looking for a recovery center or a sober center, just a safe and dry place.

Additionally, they want to raise funds for an ‘Arise Prevention Team’ on campus. This would train people on campus to be interventionists.

Lastly, they want to raise funds to do outreach into area High Schools.

Volunteers of America

Contact: Pat Cashell ([email protected]) and Sandy Isham ([email protected])

Mission or Purpose:Volunteers of America is the largest non-profit provider of affordable housing in the U.S. It was started by the same family as who started Salvation Army. Locally, in Reno, they operate three homeless shelters: (1) a men’s facility with 160 beds, (2) a women’s facility with 50 beds and (3) a family facility with 27 beds. Their mission is to reach and uplift all people.

Description:Through the shelters, VOA tries to help with sufficiency and long-term housing solutions. Most individuals who stay at the shelter have a case plan that combines services to develop life-skills and other sufficiency needs including treatment services when iden-tified as a need. Every individual who comes to the shelter is assigned a case worker to help understand the individual’s needs as well as their goals. VOA also runs the ReStart program. ReStart is an umbrella organization offering a myriad of professional services for families, seniors and people with disabilities. All of their programs are designed to reduce and prevent homelessness, increase self-sufficiency and stabilize individuals and




families to build a secure and stable future. ReStart includes the Mental Health Support Center as well as Homeless Prevention.

When people first arrive at the VOA campus, they are likely to encounter an outside monitor. The outside monitor serves two roles – outreach and security. If someone is looking to stay at the shelter, they will facilitate the arrival for a newcomer.

The family shelter typically has a waiting list; however, the wait time can vary greatly. Permissible lengths of stays are: Family Shelter – 6 months (avg. is 4 months), Men’s Shelter – 90 days, Women’s Shelter – 90 days. Then, individuals must wait 6 months to get back into the shelter. When the shelter is full in the winter, individuals can go to the Winter Overflow facility, which supports 85 men and 15 women. The services at Winter Overflow are limited to a bed, bath and a blanket. Typically, demand grows at the end of the month when people have spent their social security money. The VOA also provides a resource center for people, which includes a telephone, a computer and mail access.

Each shelter has rules: Everyone must sign in and out, kids must be with their guardians, everyone has to follow their case plan, individuals must dedicate 20 hours to work search each week, attend parenting classes, develop financial literacy, refrain from all alcohol or drug use, allow random room checks and obey curfews. There is no drug testing at the shelters due to limitations placed on the VOA by their HUD funding.

There is a day area outside of the shelter, adjacent to parking lot, which was historically known as ‘The Pit’. Now, this area is getting a playground, and being renamed Rotary Plaza, to reinforce the idea that this is a place of hope.

In addition to the three shelters, VOA also operates the ReStart Program, which serves the chronically homeless with disabling mental health conditions.

Population Served:Over 100 people in scattered site housing throughout the community. Over 1000 men served per year. Across all of the programs, VOA services over 700 unique individuals daily and 7,700 unique individuals per year. For the men and women’s shelter you must be 18 years old to stay at the shelter and you must make less than $1200/month.

Additional Comments:Pat and Sandy commented that there is a huge gap for families in the community. The VOA family shelter is always full. If Child Protective Services finds out the family is turned away then the children will go to foster care. They mentioned that if the VOA had a slush fund to put people up in a motel for a week it would be very helpful in keeping families together.

To better understand how the homeless population struggles with addiction Pat and Sandy recommended meeting with the caseworkers at the homeless shelter. These indi-viduals are more closely tied to this information than the people we interviewed.



Pat and Sandy indicated the biggest needs for the VOA and their populations are:

1. More transitional housing

2. More case workers - $50,000/year

3. Bus passes


Contact: Ken Retterath ([email protected]) and Shawn Marston ([email protected])

Mission or Purpose:The goal of the Washoe County Crossroads Program is to break down silos between organizations that deal with the same population, to serve homeless who struggle with addiction and to save the county costs on treating ‘Million Dollar Murray’s’.

Description:Clients arrive at Crossroads through referrals from the jail, WestCare, CCNN Emergency Services, CAC, the courts, self-referrals and referrals from existing community members.

When clients first show up, they go through an initial intake with a residential manager. They then sit down with a social worker who writes-up a social history and develops a case plan (number of meetings, classes, what groups to join, etc.). Residents meet with social worker once a week and are paired with a drug and alcohol counselor.

The program started with six beds available for serial inebriate populations with a focus on the most challenging cases. All clients are homeless and 85% or more have mental health disorders. However, Crossroads is not the place for serious mental health cases. More recently, the program was expanded to include mental health programs (18 beds) women’s programs (24 beds off-site at Catholic Charities) and Veterans programs (20 beds). Now Crossroads has a total of 120 beds plus a few emergency beds for those who need a place to stay ‘tonight’. The sole owner of the Washoe County Crossroads Program is Washoe County Social Services.

The focus of the Crossroads program is transitional housing with wrap-around services. The program is unique in that it focuses on highly individualized care and has no min-imum, average or maximum stay. Clients must abide by program rules, which require them to take a breathalyzer four times/day. The program provides a home and is not

mailto:kretterath%40washoecounty.us?subject=



a homeless shelter; therefore, clients are responsible for cleaning, gardening, laundry, chores and meals. The model is a community justice model. Crossroads provides food stamps and food from the food bank. The community operates on a ‘token’ economy system. Tokens are used to pay for food and lodging, and are earned through partici-pation in counseling, group support or vocational development sessions, and through community service.

Early in their residence, clients are matched to coaches/mentors/counselors and case managers. These relationships help clients to access benefits, community volunteer op-portunities, medical care, support groups (AA, NA), women’s group, wellness programs (e.g., art group, exercise group), goal setting, ‘Getting Ahead Program’, etc. A computer lab on site aids in training on how to build resumes.

The following programs partner with the Washoe County Crossroads Program. Wash-oe County Sheriff’s Office, Catholic Charity Services of Northern Nevada, WestCare, Veteran’s Resource Center, Smile Restore, Reno Justice Specialty Court, Reno Munici-pal Court, Let the Spirit Live, Alta Vista, JTNN, Department of Alternative Sentencing, Northern Nevada Adult Mental Health Services and Crossroads client’s themselves.

In particular Crossroads has a strong relationship with the Washoe County Sheriff’s De-partment, jail and court systems. For example, Judge Pearson (young offenders pro-gram) holds mock court on site to prepare clients for their court dates. Their referrals come from several community organizations. However, most are from the jail, self-refer-rals, WestCare, Reno Municipal Court, Reno Justice Specialty Court and NNAMHS.

Crossroads has decided not to take on Federal dollars, which allows for greater flexibil-ity in services. In the example provided Crossroads said, clients can’t smoke in a SAM-SHA treatment program, which leads to more failures/drop-outs; Crossroads clients can smoke. Also, federal dollars emphasize metrics such as short length of stay and other data. Here they emphasize outcomes.

The major metrics tracked are related to cost-savings to the county. Crossroads measures cost per encounter (jail booking, jail bed, treatment, WestCare detox, first responders, etc.). They also look at the economic impact of the homeless/alcohol problem on the city, for example, on 4th Street businesses.

Crossroads pays rent to Catholic Charities for their buildings. If clients can pay rent they pay $187.50 a month (versus standard of $155 per week which is average for transitional housing in Reno).

Population Served:381 clients have been served since the start of the program.

Additional Comments:The cost to support the program is $25 per day per bed. Their current bottleneck to



making a bigger impact is more beds. Crossroads hopes to double their program to 240 beds. They also believe their clients could benefit from a ‘dry houses’ so that clients have a safe place to go when they leave. During our time at Crossroads, they empha-sized that they, as well as Reno in general, have a serious capacity issue when it comes to in-residence drug and alcohol treatment. They indicated that there are not enough beds to match the need of the community. The first place of limited capacity is treat-ment programs; the second place of limited capacity is transitional/supportive housing. Lastly, they would be able to graduate more clients out of the program if there was more vocational training/job placement, with emphasis on full-time/permanent jobs instead of temp work. Currently, Crossroads always has a wait-list and their beds are always at capacity.

Washoe County Department of Social Services

Contact: Sheila Leslie ([email protected])

Mission or Purpose:Washoe County Social Services works to ensure:

1. Every person is served with dignity and respect and should be assisted courteously.

2. Every person has a right to lead a healthy, safe existence, which will promote his/her capacity and opportunity to become a responsible, productive citizen.

3. Adults should be held accountable for their behavior as it affects themselves and their duties to their minor children.

4. The family has primary responsibility for caring for children and for teaching appro-priate behaviors and values.

Description:This department handles Child Protective Services, and the cross-over to Juvenile Justice. They also do adult services and soon will take over senior services. Once this occurs, they will cover all ages for mental and behavioral health.



Programs and services offered include the following:The Children`s Services Division encompasses the following programs:

1. Adoption Services

2. Foster Care Services

3. Independent Living

4. Child Care & Early Childhood Services

5. Child Protective Services

6. Clinical Services

Adult Services include:1. The HCAP Medical Program, which reimburses medical and institutional facilities for

eligible participants who do not qualify for Federal, State or community programs. Program eligibility is income and asset based.

2. The Adult Group Care program, which reimburses costs of room and board for indi-viduals who are homeless and who require a temporary, structured setting to stabi-lize a medical condition. Social Workers assigned to this program area provide case management services and assist with applications for available resources including Social Security and Medicaid. Program eligibility is also based on income and assets. Individuals who have income must pay towards their cost of care.

3. The Extended Care Facility program reimburses medical costs for individuals placed in a nursing home. Eligible individuals must have income below the cost of care for the facility and not qualify for Medicaid. Social workers assigned to this program area provide case management services and assist with applications for available resourc-es including Social Security and Medicaid. Eligible individuals with income must pay towards their cost of care.

4. The Burial/Cremation program reimburses the basic costs of burial/cremation for individuals who do not have income/assets available to pay for final expenses.

5. The Adult Protective Service program provides information and referral services and limited case management to vulnerable individuals ages 18-59 who are in danger of abuse and neglect. This program is not mandated by NRS.

6. The Supportive Housing Program reimburses housing costs for individuals who are homeless. Eligibility for payment of rent is based on income/assets. Individuals with income must pay toward their cost of care. Social workers assigned to this program area provide case management services including referral to drug/alcohol treatment

http://www.washoecounty.us/socsrv/socsrv_adult_hcap_hcap.html

http://www.washoecounty.us/socsrv/socsrv_adult_hcap_adultgroupcare.html

http://www.washoecounty.us/socsrv/socsrv_adult_ExtendedCare.html

http://www.washoecounty.us/socsrv/socsrv_adult_hcap_burial.html

http://www.washoecounty.us/socsrv/socsrv_adult_hcap_aps.html

http://www.washoecounty.us/socsrv/socsrv_adult_ga.html



and assistance with applications for available resources.

Sheila is the Behavioral Health Program Coordinator for all age groups. This is a new position, focused on building a comprehensive behavioral health program in Wash-oe County. In her opinion, the biggest problem they have had in Washoe County for years and years is access to treatment. Also, some agencies are not up to date on evi-dence-based treatment.

The Dept. of Social Services has traditionally focused most of its behavioral health ef-forts on abused and neglected children and their families and is now reaching out to provide more access to care to indigent persons, especially those in the criminal justice system. The Department partners with Catholic Charities of Northern Nevada to operate the Crossroads Program to provide a tiered Housing First approach to high-complexity homeless persons.

Her hope is to expand treatment capacity, training opportunities and access to care for those in need of substance abuse and/or mental health treatment. 100% of child abuse and neglect cases are referred through the court system. Her department is providing more proactive services to help keep families out of the court system. The department contracts out all services for mental/behavioral health evaluation and treatment.

Sheila stays connected to and collaborates with the following organizations and individuals:

1. Denise Everett at Quest Counseling on treatment

2. Dr. Tracy Green and Richard Whitley at the State Department of Public Health for help navigating Medicaid and influencing policy

3. Dr. Joe Haas in Juvenile Justice

Population Served:Washoe County residents.




Contact: Dr. Byron Green ([email protected]) Katherine Loudon ([email protected]) Michael Doering ([email protected])

Mission or Purpose:The Washoe County School District (WCSD) is focused on creating an education system where all students achieve academic success, develop personal and civic responsibility and achieve career and college readiness for the 21st century. In the WCSD, elemen-tary schools typically include kindergarten through sixth grade, middle schools include seventh grade and eighth grade and high schools include ninth grade through twelfth grade. In 2013, a student opened fire at Sparks Middle School, a Washoe County School District school. Two students were critically injured and a teacher was fatally shot while trying to intervene with the student. The gunman then committed suicide by shoot-ing himself. Students from the school were evacuated and were placed at Sparks High School, where they held until they were picked up by their guardians. This incident has a heightened awareness and attention paid to mental health in the school district.

Description:The school district uses SAMHSA’s CSAP six strategies to measure progress in their pre-vention programming.

1. Dissemination of Information: WCSD implemented a community-wide social norm-ing marketing campaign and well as deployed the youth risk behavioral survey.

2. Prevention Education: WCSD implements a variety of SAMHSA and CASEL approved programs. The MindUP program has been purchased for all schools and is being im-plemented by the teachers. SAMHSA endorsed prevention programs are selected by counselors and guidance and take place at the elementary level. WCSD does not have middle school health or wellness curriculum so there is a gap in programming at that grade level. At the high school level prevention programming is implement-ed through the health curriculum. All high schools use Too Good for Drugs and Too Good for Violence programs. Across the district the following prevention programs are being implemented: Second Step, Too Good for Violence, Too Good for Drugs, PATHS, Steps for Respect, Get Real About Violence, I-Safe and Positive Action. The Second Step program is in all elementary and middle schools.

3. Alternative Activities: There is a big gap in offerings around alternative activities. Currently, WCSD offers no Friday night lights programs or other alternative programs

mailto:bgreen%40washoeschools.net?subject=

mailto:kloudon%40washoeschools.net?subject=

http://en.wikipedia.org/wiki/Kindergarten

http://en.wikipedia.org/wiki/Sixth_grade

http://en.wikipedia.org/wiki/Seventh_grade

http://en.wikipedia.org/wiki/Eighth_grade

http://en.wikipedia.org/wiki/Ninth_grade

http://en.wikipedia.org/wiki/Twelfth_grade

http://en.wikipedia.org/wiki/Twelfth_grade



in the evening. The alternative activities that do exist come from Boys and Girls Clubs or some other alternative activities grant.

4. Community-Based Processes: Unknown

5. Environmental Approaches: Unknown

6. Problem Identification and Referral: Intervention for indicated and selected popula-tions are areas of real need. School psychologists spend most of their time testing and don’t have as much background in therapy, which the students need. The school district relies on the community to serve their indicated and selected populations.

Population Served:The student population is 46 percent white; 39 percent Hispanic or Latino; 4 percent Asian; 2 percent American Indian/Alaskan Native; 2 percent African American; 1 per-cent of students self-identified as Pacific Islander and 5 percent of students are of two or more races or ethnicities. The WCSD serves approximately 63,000 students across 93 schools including: 64 elementary schools, 1 special education school, 14 middle schools, 13 comprehensive high schools, Truckee Meadows Community College High School, Washoe Innovations High School (an alternative school) and the Academy of Arts, Careers and Technology.

Additional Comments:A major barrier for WCSD is the constant tie to grant funding which provides a certain amount of money for a certain amount of time after which the school district is supposed to sustain the funding. This approach is very difficult on WCSD and results in a fragment-ed continuum of prevention.

In selecting programs WCSD looks to CASEL, SAMHSA and OJJDP and selects pro-grams based on the risk factors and the prosocial behaviors they desire as outcomes.

WCSD feels proud that they have universal climate and safety surveys that allow them to look at metrics and provide data on a school by school basis.

The counselor student to student ratio shows a gap in services. Currently, in WCSD, the high school counselor to student ratio is 400:1 while the elementary school counselor to student ratio is 775:1.

The WCSD feels they have been lucky over the past three years in regards to funding. The CASEL grant that supports MindUp has provided approximately $1 million/year but it is ending soon. The school district also has a grant providing approximately $50,000/year to implement the PATHS program. The Project Prevent grant is also providing ap-proximately $1 million/year to support prevention efforts.



Observations from the Community Mapping Team

Gaps in Research

In total, 20 interviews were conducted during this asset mapping activity. There were a couple of organizations that were initially identified in the primary research; however, an interview could not be coordinated in a timely manner. Of note, interviews with Quest Counseling and Rural Health Partners are absent from this study. The absence of these interviews is a recog-nized gap in this research. An additional gap is the absence of an interview with WestCare. Primary research did not identify WestCare as an influential asset; however, in the process of community mapping it became clear that WestCare is a critical asset in the community. Lastly, much like WestCare, during the community mapping process it became clear that the Specialty Court Judges in Washoe County are also influential assets. The addition of their names, data, comments and efforts is important to accurately map the prevention, treatment and recovery assets in Reno and Northern Nevada.

Public Service Emphasis

This report emphasizes the services available to the broadest community or a typical Reno resident. It does not highlight those prevention, treatment and recovery support services that may be available to the highly privileged. When continuing and expanding asset mapping work, it is recommended that private centers be interviewed.

Prevention in Schools

The landscape of prevention in schools is far too variable. The funding cycle for prevention programs is often three or fewer years, meaning that over the course of a student’s education they may be exposed to a series of prevention programs rather than a consistent method or program with proven, evidence-based outcomes. This short funding cycle also requires excessive administrative time to acquire funding for new programs and training for staff. A more consistent prevention programming scheme would create efficiencies in administrative time allowing for the dedication of more time and resources to ensuring programs are imple-mented with fidelity.

Increased Attention to Behavioral Health



Everyone interviewed talked about behavioral health, cognitive behavioral therapy and wrap-around services. This is a new era of health care in which people are not just concerned with or treating physical health but instead treating the whole self. Everyone is trying to navigate this shift at the same time; for some professionals and organizations it can feel like a strain – having to do more with the same amount of resources. For others it can feel empowering. For many, this is requiring them to create micro communities within the macro environment. These micro communities result from the linkages and collaboration between service orga-nizations. Ultimately, it is hypothesized this will result in better care and better results for the people served; however, it is important to remember that for many professionals and organi-zations this is still an emerging concept.

The Justice System

The vast majority of individuals navigating the prevention, treatment and recovery support landscape are a product of the justice system; and, the justice system in Reno is willing to serve juvenile and adult substance use-related offenders in a way that will help them on to the pathway to recovery. It seems there are a lot of alternatives to incarceration for sub-stance-related offenders and that the people of this community are working hard to improve and expand these services.

Connections in the Community

Reno, like many places, is a small big city. STEP2 and CASAT in particular mentioned that net-working in the community has significantly contributed to its success. The professionals and organizations that are contributing to the prevention, treatment and recovery continuum of care are pretty aware of one another and the services that are offered. This is an asset in and of itself given that there are many places across the country where this is likely not possible or not occurring.

To Accept Federal Funding or Not

There appears to be a debate within almost every organization – will they or won’t they ac-cept federal funding. To accept the funds means greater stability but limits the type of care that can be provided. To not accept them means greater provider freedom but likely requires increased attention to fundraising. This is the debate and there are varying opinions in the community. Regardless of the decision, it is observable that organizations can be successful.



Challenges of Medicaid Expansion

Many providers are currently in the process of reacting to Medicaid expansion. This has required new administrative processes that at present are tiresome to some organizations. It is likely that this is a result of the newness and that in time organizations and their systems will make the necessary adaptations.

A Gap in Case Management

Based on the interviews conducted, further research is needed to fully quantify and compre-hend the gap in case management in Reno. Many interviewees cited a need for more case management for clients and patients. Essentially, helping people navigate from a problem to detox to treatment to transitional living to transitional housing to subsidized housing is important and there just aren’t enough people who know the system well enough to help those who don’t.

Optimism

Overall, the professionals and organizations we spoke with were optimistic. No one said Reno and Northern Nevada’s problems were too big to solve. The assumption is that any needs are addressable. And that this certainly is not a desert of prevention, treatment and recovery support services.

The reality is that the disease of addiction and the recovery journey is an individual experi-ence and no two are alike. Navigating a continuum of care and support can be extremely challenging for anyone when you never know what is coming next – this alone prohibits peo-ple from realizing their full potential for recovery.



Initial Capacity-Building Recommendations

Adrian’s story was offered at the beginning of this document because he left us with the question: Where do you find a trusted source? As he pointed out, he had the good fortune of making his first call to someone who was able to refer him to the founder of a national non-profit that is committed to transforming youth recovery - one community, one school, one student at a time.

But what if you’re not that lucky?

This report is the beginning of the answer to Adrian’s question, the first step toward multiply-ing the number of trusted sources present on that first day of a desperate search for support toward recovery. Almost everyone interviewed during recent asset mapping activities is striv-ing to emulate the best qualities of being a trusted source; everyone is working to connect their clients or patients to the next service provider or the next transitional home or the next counselor. However, it is the first call that either does or does not open the right door to this interconnected network of sources.

Doors to Recovery can make a significant contribution to Reno and Northern Nevada’s ca-pacity to rapidly connect those in need of care and support to the right prevention, treatment and recovery assets by equipping and empowering those who get the first call. In doing so, the effort can further assist those who need to make calls along the way.

At the level of individuals, it is about creating a network of people who can function as “path-finders”—helping those who are navigating the continuum of care to more rapidly find the right first step or right next place.

At the level of organizations, it is about building awareness around how everyone is con-nected and having immediate access to the information they need to confidently transition people to the next step.

At the level of community, it is about making visible what is available for those seeking care and support and using that knowledge to identify any gaps or barriers to helping people be well.

To do this two primary activities are initially recommended:

1. The first activity is to populate a web application with the information gathered during this study to capture and create the resources that can be most helpful in identifying the right doors to open first. The idea is to encourage broad community participation to record and keep current prevention, treatment and recovery support “profiles”. These profiles would include details on services and programs as well as the stories on those



who access and benefit from such services and programs. Collectively, the data details in combination with illustrative stories will allow for automated creation of profiles that those receiving first calls can use to guide responses and make appropriate connections. The application will allow organizations to identifiy as any of the following: Health & Well-ness, Housing, Recovery Support, Prevention and Intervention or Treatment Services. The owners of each program should be responsible for the ongoing upkeep of information. Overtime this application would build to allow programs and users to endorse one an-other as well as indicate collaboration and referral sources as well as generate network models that illustrate how professionals and organization are connected.

2. The second activity is to commit resources to the development and coordination of a Pathfinders initiative. The idea is to recruit and support influential connections (individ-uals and organizations) to serve in a way that partially fills the case manager gap. Path-finders are the first call - connecting those individuals and families who need assistance navigating the continuum of care with the right first step (be that the right next contact or the right first service or program.) Once oriented, Pathfinders can leverage the data in the Capacitype web application to access profiles, resources, tools and make the necessary connections.

Looking back once again on Adrian’s story, here are a few things we imagine sharing with Pathfinders:

I. Make yourself known as a trusted source– someone with a broad range of contacts and the expectation that calls would be returned.

II. Remember that you might be up to three degrees of separation from the final an-swer, just as Adrian’s trusted source was. (He got Adrian to Stacie, who got him to Steve, who got him to John, who had the solution.)

III. Model what those helping Adrian did: (1) Ask what happened; (2) Tell them your sto-ry; and (3) Get back to them with actionable information within 24 hours. By asking them what happened, you will get information that will help you line up the right resources, and you will begin the sense of relationship that is so vital to the person you’re helping. By telling your story (and you must have one, or you wouldn’t be in this chain of phone calls), you take that sense of relationship to the next level. And you promise to get back with answers quickly because you know it’s a matter of hours, not days, before they need to do something.

These two initial recommendations reflect the essence of building capacity for helping those who are in need of care and support in and around Reno. In and of themselves, the activities are straightforward. If done to their full potential, they can have a profound ripple effect of height-ening awareness of prevention, treatment and recovery support assets in the community. Per-



haps more importantly, they can make visible the doors to recovery and any actions or policies that may be keeping them locked.

A final note on the importance of including prevention efforts in the capacity building conver-sation. From our perspective, capacity building is as much about ensuring that adequate re-sources are available for those in need as it is about diminishing future demands on an already stretched system of professionals, organizations and advocates who wanted to help people be well. There is an immediate need to expand support and encouragement for what is working well in the present. And there is a need to do so in a manner that enables sustainability in the long term.



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