Episode #56

Rehabilitating Recovery Residences

Featured Guest: John Lehman

For today’s show, I’m joined by John Lehman of the Florida Association of Recovery Residences or FARR. He has served FARR in a number of capacities over the years, including most recently as president and board member. John sat down with me at the Moments of Change conference in Florida to describe the current landscape of sober homes and other recovery support services in that state and illuminate the challenges facing FARR as they work to regulate, educate and ultimately improve the recovery residence field for the benefit of those who need help most.

Podcast Transcript

David Condos: Hey, guys, welcome to this episode of Recovery Unscripted, a podcast powered by Foundations Recovery Network. I’m David Condos. For today show, I’m joined by John Lehman, of the Florida Association of Recovery Residences also known as FARR.

He’s served FARR in the number of capacities over the years including most recently as president and board member.

John sat down with me at the Moments of Change conference in Florida, to describe the current landscape of sober homes and other recovery support services in that state, and to illuminate the challenges facing FARR as they work to regulate, educate and ultimately improve the recovery residents field for the benefit of those who need help most.

Now, here’s John.

I’m here with John Lehman, thanks for your time today.

John Lehman: Thank you, David. Glad to be here.

David: Absolutely. First, let’s have you tell us a bit about your personal journey and what drew you to this world of recovery.

John: Well, what drew me to recovery was addiction. [laughs] I began my recovery journey, in earnest, back in 1978 and it didn’t fare well because I discovered in my first treatment center that they wanted me to give up all the alcohol and drugs.

I was only interested in passing out a few of them that I thought were causing me problems. I wasn’t committed to the process and then I woke up in a non-medical detox facility in 1980 in Delray Beach, and I didn’t know that there was a Delray Beach, didn’t know how I’d gotten there.

There wasn’t anyone left on the planet that was willing to take a collect call. That began my recovery journey and I didn’t stay sober for that entire time till now. I had some long-term recovery. I relapsed back in the 90s.

In 2007, I was in a non-medical or in a medical detox four times that month of October, 2007. I wanted to be clean and sober, I was trying to do all the right things, but I just couldn’t do it, I just couldn’t stay clean and sober.

I’d given up hope, I moved into a recovery residence that was willing to take me. From that spot of absolute hopelessness, I began to take the actions that were necessary to build a program of recovery that has sustained me so far.

Then what happened is, I was asked to participate in some outreach work for the Florida Association Recovery Residents, in the first year of its existence here in Florida. Then that led to my being asked to step up and take a leadership role.

Then there were just great opportunities to fight back against NIMBY legislation that was being proposed, and I’ve learned how to craft legislation to improve the quality of services that were being provided and to measure recovery residents’ compliance and standards that have been established by the National Alliance for recovery residents now.
I’m surrounded by people that have been doing incredible work for a very long period of time all to the benefit of my trying. I get to take the ride with them. I like being me.

David: OK, yes. That’s cool that you have that experience, you were in a Florida recovery residence and that was a big part of your journey.

John: I was in many Florida recovery residents. I always say when I get up in front of a group that my credentials for being a leader in this industry is that I’ve lived in more recovery residences than most people have spent days in hotel rooms. I know a lot about what works and what doesn’t work.

David: Yes. To back up a little bit, how would you explain FARR’s mission, in particular, to someone who’s not familiar?

John: We are the credentialing body for the state of Florida and there’s a statute that requires recovery residences who wish to be eligible to receive referrals from licensed behavioral health care providers, to be certified to 37 national standards that were promulgated by the National minds for recovery residences.

FARR’s mission is to measure the environment to be compliant with our quality standard. Then the second is to increase the best practices that are delivered within that environment that measurably enhance outcomes.

David: To set the foundation for the next couple questions, could you just give us an overview of the current landscape here in Florida related to sober homes?

John: Well, yes. I’m largely credited with blowing the whistle although there were many of us that participated in that activity. We’ve heard a lot of negative press and we probably will hear some more negative press about the challenges that south east Florida, in particular, has faced in sober home world.
All that relates to the intersection between addiction treatment, particularly, outpatient treatment and sober homes.

It’s all true, it’s all true. What isn’t true is that it’s a southeast Florida problem. It’s true in California, it’s true in Texas, it’s true in Pennsylvania, it’s going all over the country. What’s true is that we’ve pushed back against it and we called attention to it and that led to the attention of the law enforcement, eventually.

It took us two years to get law enforcement engaged and then eventually the media picked up on that. It’s part of the process, we’ve got to go through the negative to get the good. Here’s what I see happening. What I see happening is that municipalities that originally were all focused on how do we get rid of sober homes? When I arrived here five years ago, the mission was to get legislation that would empower the municipal governments to just kick them out of their residential neighborhoods.

David: Yes, that’s the NIMBY stuff you were talking about earlier.

John: Yes, and now we’ve got Delray Beach that has passed an ordinance that says that in order for us to renew your reasonable accommodation, you need to be FARR certified. All this is good action.

It’s all positive, because now these sober homes can legitimately come out of the closet, they can walk into the planning and zoning department, they can announce who they are, what they are and they can legitimately get licensed to provide service in their community.

Communities are beginning to appreciate that there is a very finite distinction between the good guys in the bad guys. Communities need quality service providers in order to address those overarching problem of addiction that’s a crisis that the entire nation is facing.

I also think that the media’s beginning to understand what happened here was that we pushed back. When I say we, I’m not talking about FARR or John Lehman, I’m talking about the ethical law abiding quality programs in both the addiction treatment and the recovery support space, pushed back against these predators that had invaded our space.

FARR became the platform through which they funnel the information in because somebody had to become the collection point and we did. We funneled it in and demanded that state legislatures pay attention, that law enforcement pay attention.

David: Yes, because if you’re good program is doing things the right way, it benefits you to make sure everyone has to do things the right way.

John: Exactly. That was one of the drivers, the other driver is that these good programs are in the business of trying to help people and they saw what was happening to the people that were being attracted by this inducement.

Come live here for free in the sober home, we’ll feed you, we’ll give you a cell phone, we’ve got all sorts of toys for you to play with. The only thing you’ve got to commit to doing is getting on the van and go on over to the IOP, peeing in a cup three times a week and spend a couple hours in group therapy and then you get to party.

Frankly, we don’t even care if you’ve got a substance use disorder as long as you’ve got a good insurance policy. Was that everyone down here? No. 20-25% were bad guys entered the space just as predators on this vulnerable population.

25% were the good guys that were doing the right thing just because it was the right thing and sometimes they made money sometimes they didn’t. But the middle ground, they didn’t know any better. What they saw was that nobody’s getting charged for this activity so it must be legal.

They’re going to gravitate to where the money and they started to participate in these bad practices. Now, what we’re saying is that that group is saying, “Okay, all right, we’re confused. Tell us how to do this the right way.”

About half of that group, when they discover how to do it the right way, they say, “We don’t want to do that, that’s too much work and there’s not enough money in that.” They’re just getting out of the space.

Some of the bad guys are just moving to a different locale. They’re, well, if it’s not good here anymore, we’ll find another space where we can do it. That’s a shame because, ultimately, they’re taking advantage of the population.

David: It’s becoming more of a thing, like you were saying, Delray, Boynton Beach, some of these cities are making FARR a rule, a real standard that they have to abide by. What’s that process look like to become certified? What are the requirements for that?

John: There’s an online application and we’re going to ask you about your program, we’re going ask you about your staff plan, we’re going to ask you about your locations. You’re going to sign an agreement and the agreement says that we can ask you your underwear size or we can look at your bank statements. You’re going to agree to letting us look at anything we want to look at, in order to determine you’re are one of the good guys.

Now, we don’t often go to that extent. We don’t go in and say, “All right, give me bank statements for the last four months.” We want the ability to do that and we also want the ability that if we ask for that and you say no, then we want to be able to revoke your certification.

In our published quality standard, there are 37 standards and every single one of those standards has a section that says, as evidenced by. There’s a very clear and finite concrete explanation of what we expect, you as a provider to be doing in order for you to achieve compliance with that standard.

Frankly, one of the challenges that we experience as a credentialing body, is that a lot of people don’t want to read through that. They just want to hear, all right, I pay my fee and you’re going to come out and you’re going to inspect my property and then I’m going to get a certificate of compliance and you’re going to can come back next year.
That isn’t what happens. We expect you to have a policy and procedure manual and a staffing plan and even if the staffing plan, it’s me and I do everything, but this is what I do.

Then once we’ve crossed that bridge, then the next step is on-site field assessment where we’re going to come out.

That is maybe 25% related to the property and 75% related to, are you, in fact, implementing the policies and procedures that we approved on paper in practice? How do we do that? You take us through your intake enrollment processes, you take us through to all your forms, as if we were a brand new resident.

You take us through the handbook and commuted roles, you take us for a tour of the property. Then we’re going to go and we’re are going to interview staff and we’re going to interview residents separate from you.

We’re going to ask some questions because we know what you say you’re doing. We’re are going to ask them questions to determine whether or not that’s what they’re experience is. Either one of two things is going to generally take place.

Either we’re going to issue a corrective action plan that says, you got to do these things in order for us to issue a certificate, or it we’ll issue any suggested enhancements, and that’s, you did great. There are some things that you could do better.

Then about ninety days out from the expiration of that annual, they’re going to get a notice, time for us to do this again. In between, we have two things, grievance. There’s a form on our website and any stakeholder in the community can file a grievance and that may trigger the need for a field assessor to go back out to the property and to confirm whether that is a challenge.

The second is if we have field assessors that are going out into that area to do a new program or a renewal, we often will send them over to do a compliance audit of the nearby program while they’re in that area. The focus isn’t catch you, the focus is who’s doing some of these more difficult things really well?
Then, how are they doing that? Would they be willing to go in front of their peers at a lunch-and-learn and share their experience, strength and hope?

David: As we touched on earlier, Florida, specifically, has had some state governmental action recently to take action to protect patients and try to regulate the industry. Could you say a little bit about how some regulations that have recently passed or are coming down the pipe, how they’re affecting FARR’s work?

John: There is a belief system out there that FARR is responsible for having killed the golden goose. That we’re responsible for the insurance companies withholding payment and all the negative publicity that the media has brought to the issue of insurance fraud and patient brokering is our fault.

Frankly, there are as many excellent programs that, there hurting too because negative publicity hurts everybody. They recognize it was absolutely necessary and they were participatory.

They’re the ones that funneled the information into us that that would allow for us to work with the FBI and with the department of insurance fraud and with the state attorney’s office and frankly are still doing it.

One of the challenges with legislation is that if there’s no money behind it, it’s hard to make it actually happen. That’s certainly a challenge in Florida. The second problem is that it is developed over time.

Just because you say it is now law, doesn’t mean that it was really thought through all of the challenges to implementing that law. What we’re discovering is, well, that didn’t work out so good and here are the challenges with that.

Now you have, because it is a law, you’ve got to go back to the legislator, you’ve got to amend the law. That process will take place over some period of time. Then you’ve got to get the even well intentioned and willing providers and communities etcetera, educated on the law.

They need to know, well, all right, but in practical terms what does that mean and what I’m I supposed to do be doing and what I not supposed to be doing. There’s a whole process around that as well.

David: That was going to be my next question, for the good ethical programs out there, like you said, negative publicity is hurting everyone in some way. What would you say to them? What can they do to keep helping people in their community because the need is still so great?

John: The needs greater than it ever was before. The answer is don’t induce. If you want to solve the patient brokering problem, don’t induce enrollment in your clinical services platform by offering some benefit other than the service that you’re licensed to provide.

That said, if you’re able to demonstrate that offering a service that you’re not specifically licensed to provide, you’re offering it for the benefit of this specific client who needs that service and that it is in support of their wellness. Then by God do it and defend yourself if necessary.

How do we provision legitimate support for an individual that is committed to recovery, where failure to provide those support mechanisms like housing and transportation and the resources necessary to sustain themselves early in recovery until they are able to self-sustain themselves?

By not providing those resources were actually negatively impacting their recovery. We shouldn’t be in a position that we’re in, but we are in this position because the bad actors create this model, this relapse model.

What the law enforcement group had to do is they had to use a patient brokering statute to close down the opportunity for a licensed provider to provide those services that they were not licensed for.

Now, we’re trying to figure out how to create a safe harbor for the good guys to do this for the right reason. While we’re trying to figure out how to do that legislatively, my advice is that no-one at the state attorney’s office is looking to put good guys in jail.

There’s no shortage of bad guys to go after. If you have a resident or a client in your IOP and that person needs to be supported in their housing needs, and they need a packet of cigarettes because they’re not ready to quit smoking and they need a toothbrush and they need little money for food.

You go do that and you document that you’re doing it and then if you get challenged in that, you go defend yourself. This all comes down to doing the right thing for the right reasons. Not doing it because some government agency tells you this is what you’re supposed to do.

It’s another argument, David, that I have and I make this argument frequently with my friends in the addiction treatment community, is stop going to the insurance companies and ask them what outcomes they want you to track.

Do you imagine that a medical professional goes in and says to the insurance carrier, “I’ve spent the last 12 years of my life becoming a really good surgeon but I’d like to know what outcomes you’d like me to track in order for me to get properly reimbursed for the work that I do.”

That’s not how surgeons play. Surgeons tell insurance companies this is what we’re going to track because this is what’s valuable to know —

David: They’re the expert in what they’re doing.

John: Yes, we’re the expert. We’re the professional. If you’re claiming to be professionals in the treatment of this medical condition addiction, then you tell the insurance companies what outcomes you’re gonna track. I can tell you in the recovery support services, I want to know, are they employed? I want know what job satisfaction they have. I want know what their earnings capacity was when they left.

Were they doing any community service? We’ve got all sorts of research that demonstrates that when people actually give back, contribute to their community, right at the beginning of their recovery. You don’t need to be 10 hours a week. You can do two hours a month.

You start with this mind frame that says, that I need to be a contributor. I’ve been a taker all my life, now I’m going to start giving back. These are the kinds of metrics that we would expect that a recovery residence is tracking and there’s about 20 more that I won’t tie us up with.

My point is, those are outcome metrics. This is where the group started. This is where the group ended. If I created this peer community, one thing that happens when you build a fraternity or a sorority, is people don’t want to leave and when they do leave, they’re anxious to come back and feel that sense of connection and continue to participate.
What is healthier for a person in early recovery, than they to have guys and gals, that are coming back to that recovery residence, that have been actively engaged in life and succeeding in their first year and two years and three years of recovery.

It’s just contagious. So we need more contagence, positive contagence.

David: Looking into the future a little bit, what do you see happening over the next couple of years in this field? Specifically here in Florida or in a more general sense.

John: I think that there is a focus on integrated care and I think that when we talk about integrated care, we talk about medical and behavioral, but I think that’s gonna expand. So, behavioral change does not take place in a classroom, and ultimately a group therapy session is a classroom and a one on one session with the therapist, is a tutorial.

I do learn in that process and it is valuable, but that’s not where the change takes place. The change takes place out in the real world and so recovery community centers and recovery residences and recovery employers and recovery cafes.

This recovery oriented systems of care and support infrastructure that William Whyte talked about, I think we’re seeing it emerge and a lot of work has been placed in that by Favor to research the efficacy of some of these practices.

Hopefully what comes, and I’m certainly a promoter of this, but I think others are as well, that we move from an approach where medical is detox and behavioral is clinical and recovery support is aftercare, and we come to really appreciate that it’s all care.

Where we need within the space to continue to talk to one another, engage one another. It’s not, we did this and then we transferred them to you, now he’s your baby. It needs to be an individual continuum of care and support and we need the software solutions and the HIPAA and the CF42 clearance, to be able to communicate with one another and support that person.

I think that we’re getting there. I think that’s what the future of this industry holds for all of us.

David: Last question. Everyone who serves in this field has their own personal reasons for wanting to get up each day and further the cause of recovery. To close this out, could you sum up why creating better opportunities for people in your community to find recovery, is important to you?

John: Yes, I can sum that up, because when I wake up in the morning, I feel good about being me. I feel good about what I do, and strangely and oddly, I have been able to contribute in a way that’s meaningful.

As I said earlier, I don’t come here with a set of credentials that many people have earned or who get to play at the level that I get to play and I just get to hitch on to their bandwagon and go along for the ride with them.

It’s an amazing experience. It’s incredible. I wake up every morning very grateful for who I am and the gifts that I’ve been given and not because it’s noble or because it’s the right thing to do or because there’s some reward in the afterlife, because it’s exciting, for me, and because I feel good about it.

I get to contribute to the wellbeing of others, as best I can during the course of the day, in the company of other people that are like minded. It’s a wild ride.

David: Yes, well, John, thank you for your time. Thank you for sharing all that with us. We really appreciate you being here.

John: I appreciate being here. Thanks very much.

David: Thanks again to John for joining us. Now, I’m happy to welcome Will Heart, from the Life Challenge team. He joins us each month, to give us an update from their community, which is the aftercare support network for those who have gone through Foundations treatment programs and anyone else up for accepting the challenge of living life in recovery. Their last challenge was to take some time to treat yourself and now, Will’s back, to share a new challenge for this month. So, welcome, Will.

Will Heart: Hello. Thanks for having me.

David: Hi. How you doing today?

Will: I’m great. How are you?

David: Excellent. Excellent. So, yes, the weather’s turning, spring is coming and I’ve heard that that’s the theme for the next challenge.

Will: Exactly. We’re doing a spring cleaning, cleaning out your closet. The whole idea is springtime, it’s a new life to everything. So why not bring some new life to your house too? Getting the clutter out, picking up things you don’t need anymore.

David: Then you can pay that forward on to, donate it and give it to someone else in need.

Will: Exactly what we were thinking.

David: Awesome. Oh yes. So starting fresh this new season. I like it and as always, people can go to your website, see what other people are doing and have done and share their own experience as well.

Will: Yes. It’s at lcaccepted.com. We always love seeing all your stuff, so send them our way.

David: All right. Thank you, Will.

Will: Thank you.

David: This has been the Recovery Unscripted podcast. Today, we’ve heard from John Lehman, of the Florida Association of Recovery Residences. To learn more, visit farrronline.org. Thank you for listening today. If you like what you hear, please leave us a rating on your podcast app. We’d love to hear what you think. See you next time.