Vaughan: Challenges of Residential Treatment Programs in DC for Substance Use Disorder

Flag of the District of Columbia (Courtesy of dpw.dc.gov)

April is Alcohol Awareness Month, a national movement to draw more attention to the causes and effects of alcoholism and how to help families and communities deal with substance use disorders (SUD). This year, for organizations that provide residential treatment programs in DC, it’s an opportunity to highlight the challenges they face when providing much-needed programs to individuals.

Operating a residential substance abuse treatment program is very demanding and intensive work. Clinicians work daily to effect change in the lives of deeply broken people combating addiction and mental illness often paired with homelessness or housing insecurity. There is an art and science to creating and maintaining a healing milieu. But what has been the most difficult for organizations providing services to those trying to overcome addiction throughout the pandemic has been exacerbated by significant shifts by governing agencies.

Samaritan Inns, located in the heart of DC’s Columbia Heights neighborhood, provides structured housing and recovery services in an environment of support and accountability. We give individuals who suffer from substance addictions the opportunity to rebuild their lives. For nearly 40 years, we’ve retained highly skilled clinicians who provide quality treatment services. However, since January 2022, our programs have had four major troubling outcomes due to changes implemented that are outside of our control. One is a decrease in the quality of clinical services because our best clinicians are now overburdened with excessive documentation: two, a significant decrease in revenue because of the new complicated and broken billing process. Three, a decrease in staff morale has impacted staff retention. And four — and by far the most detrimental — is the major change and bleak outlook on how we will acquire authorizations for clients seeking long-term treatment.

For example, before January 2022, approval for an individual to receive residential treatment in 90-day increments was standard. With that, we could offer residential treatment starting with our intensive 28-day adult treatment program followed by an additional six months of structured residential treatment. Clients could focus on long-term sobriety while working on job skills and finding employment.

Now, the authorization process has been shortened to 14-day increments! With more than 70% of the people we serve also battling chronic mental illness, health issues, SUD, trauma and housing insecurity, more than 14 days are needed. Our fear is that with no assurance of long-term treatment support, we are concerned with individuals being able to sustain their sobriety in an outpatient setting, especially if they have no stable or sober housing.

In addition to the authorization process change, how we get reimbursed for our services now has to go through a convoluted billing system. While the reason for the two-week authorizations was intended to make it more person-centered, it has actually made it more difficult for clients with chronic homelessness and years of substance abuse. What was meant to improve client services has done the opposite and has led to worse outcomes for clients.

How we provide residential treatment has been drastically turned upside down and disrupted. At Samaritan Inns, alcohol is the drug of choice for the majority of the people who come to us. Therefore, as we raise alcohol awareness this month, we want government agencies and policymakers to be more sensitive to the issues that providers are dealing with, instead of creating more barriers to positive outcomes at a time when alcohol and drug abuse is on the rise in DC and in the nation.

Vaughan is president and CEO of Samaritan Inns.

Source: The Washington Informer