Program Design

The Program

A program of the Health Care Authority, the intent of RNP is:

...to provide behavioral health services to individuals who intersect with police because of simple drug possession, people who have frequent criminal legal system contact, and others who are referred from community sources. These programs are to serve people who are at risk of arrest, or already have been involved in the criminal legal system due to unmet behavioral health needs.

The program is expected to be operated under the harm reduction model:

The RNP framework incorporates harm reduction and trauma-informed care principles to support the individual throughout their recovery journey. Coordination and communication between regional RNP staff, law enforcement, prosecutors, medical providers, and community partners is essential to the success of each individual.

Quick Synopsis

Basically, while the details of each specific aspect of the Recovery Navigator Program are given below, I'll do a quick summary of the program here so you don't have to read all the things.

Modeled on the Law Enforcement Assisted Diversion (LEAD) framework:

LEAD is designed to provide care coordination for people with complex, ongoing, unmet behavioral health needs and/or income instability who may lack shelter/housing, income, food, health care, and social networks and for whom existing systems prove inaccessible, impossibly complicated, or insufficiently responsive.

In short, the program is a referral and outreach based model where individuals are referred into the program, the outreach provider makes contact with said individual, determines their needs based off of screening, and works with the individual to determine goals or case management processes to help them navigate services. The project manager oversees the local RNP implementation and regularly schedules meetings that are established to bring all coordinated parties to the table.

The general players are as follows:

The activity of these roles centered around the following:

If you are interested, the remaining details of how the RNP is structured and operates is highlighted in the content below.

Uniform Program Standards

In August of 2021, the Health Care Authority developed the "Uniform Program Standards" for the Recovery Navigator Program:

The program shall provide community-based outreach, intake, assessment, and connection to services and, as appropriate, long-term intensive case management and recovery coaching services, to youth and adults with substance use disorder (SUD), including for persons with co-occurring substance use disorders and mental health conditions, who are referred to the program from diverse sources and shall facilitate and coordinate connections to a broad range of community resources for youth and adults with substance use disorder, including treatment and recovery support services.

Definition of Recovery

The definition of recovery is a process of change through which individuals improve their health and wellness, live a self- directed life, and strive to reach their full potential, as determined by the individual’s own understanding of their Recovery. There are four major dimensions that support a life in recovery: Health, Home, Purpose, and Community.

Design

Recovery Navigator Programs should be designed to serve those who cannot, on their own, grab hold of whatever safety-net services might be locally available. Recovery Navigator programs will establish a new system of response and care for people who live with unmanaged behavioral health needs, deep experiences of complex trauma, cognitive disabilities, persistent poverty, and often lifelong experiences of punishment, failure, betrayal, and marginalization—people who are not served by office-based, appointment-based, time-delimited care.

Understanding Who Does What

Regional Recovery Navigator Administration

Great Rivers BHASO

Per ESB 5476§2§4, each BHASO region will hire an administrator to oversee the multiple Recovery Navigator Programs in their region, which shall be responsible for assuring compliance with program standards, including staffing standards. The Regional Recovery Navigator Administrator will develop a Regional Resource Assessment for their region which captures existing local, state, and federally funded community-based access points. This resource assessment will map existing agencies and funding sources which provide outreach and intervention programs.

As part of the resource assessment, the administrator will support program managers in identifying and engaging with the region’s Accountable Communities of Health, local health jurisdiction, local behavioral advisory committee, local and tribal law enforcement, and any other local or community-driven partner groups which oversee programs which could be complementary to the RNP. These partnerships must be memorialized through interagency agreements or Memorandums of Understanding. This role will also be responsible for coordinating and communicating with the technical assistance and training provider on a daily/weekly basis during implementation and bi-weekly/monthly during the operational phase.

Project Management

Cascade Community Healthcare, later, Great Rivers BHASO brought the project management in-house.

This position should be responsive and give full consideration and be accountable to the multitude of community partners, as demonstrated in establishing and convening a quarterly Policy Coordinating Group. Within this work, project management will be inclusive of persons with lived experience (both in the criminal legal system and behavioral health), as well as focus on engaging community voices which have been historically under-represented.

As part of the Policy Coordinating Group, the project manager coordinates implementation of the program amongst other systems outside the health field, including public safety advocacy and system design, law enforcement, criminal legal system representatives, and civil rights advocates, through the following:

  • Convening meetings with community partners/resources (e.g. courts, law enforcement, Tribes, faith-based organizations, Emergency Medicaid Services/Fire Departments, local health jurisdictions, Behavioral Health Treatment Providers (BHAs), medical providers, social services, harm reduction organizations, legal groups, people with lived experience, elders, family members and other supports determined by individuals in need).
  • Develop interagency agreements with these partners which support the utilization and referral to the RNP. These collaborations should be memorialized through intergovernmental releases of information, data share agreements, and memorandum of understandings. Approves community referrals consistent with resources and priorities established by partners.
  • Identify concerns and objections of local partners related to the operation of the program which create implementation access barriers and highlights these issues to leadership at the local, regional, and state levels.
  • Identify gaps in accessing services as part of continual resource mapping to help inform future expansion of resources in the area.
  • Facilitates data collection, data reporting, and program evaluation efforts.

Project Management ensures that the Uniform RNP Standards are implemented with fidelity to the model and that program outreach and communication are coordinated amongst similar existing programs in that geographical area.

Outreach, Referral, and Case Management

Gather Church and later Destination Hope & Recovery

The RNP must include staff members who spend most of their time in the field. This will inevitably include spending time visiting community-based organization and settings. The outreach and referral staff will be available to respond and engage upon referral.

RNP staff will:

  • Respond to community referrals and interact with individuals who might need case management or ongoing referrals to external services;
  • Provide short-term assistance while addressing the immediate needs of the individual (this is not long term, intensive field-based case management);
  • Facilitate a warm hand off to the supportive services identified;
  • Follow-up with program participants in the community when there is indication of disengagement;
  • Prioritize responding to law enforcement calls in the beginning stages, with long term goal of being able to respond to any community-based and emergency response referral
  • Coordinate with case management staff to meet the individual needs of new and existing program participants;
  • Collect and provide data points related to the individuals referred to the program and provides data to the Project Manager. Note: Further documentation regarding demonstrating compliance with these standards, performance metrics, data collection, outcomes, and evaluation will be provided by HCA to the BHASOs.

Outreach and Referral is an integral component of the Recovery Navigator Program.

Eligibility, Referral, and Engagement

Program is voluntary and non-coercive

Individuals referred to the Recovery Navigator Program have the right to decline participation without any penalties or future repercussions (denial of services at future point). An individual should not be referred to RNP personnel as a condition for compliance with a court sentence or deferred prosecution action. An individual is under no obligation to engage in services if referred by law enforcement, in accordance with RCW 10.31.110. There might be circumstances, where the Policy Coordinating Group agrees to examine other circumstances where an individual might be referred to the RNP (e.g. Theft charges). In those circumstances, the Policy Coordinating Group will determine if, for those alleged offenses, what the process would be for non-engagement.

Abstinence from substance use is not a requirement for any aspect of a RNP or ancillary program funded or featured as part of the RNP. The RNP will not utilize compliance monitoring through urinalysis testing or other invasive means as a mechanism to determine abstinence.

Arrest Diversion and Community Referrals

The priority population for the RNP are individuals with SUD and co-occurring substance use disorder and mental health who are at risk of arrest and/or have frequent contact with first responders, community members, friends, family, and who could benefit from being connected to supportive resources and public health services when amenable. The primary function of RNP is connection and stabilization with respect to a variety of social determinants/vulnerability factors

There are two types of referrals into RNP: point of contact referrals by law enforcement and social contact referrals by law enforcement, service providers, community members, and friends/family. The RNP will prioritize a response to law enforcement calls in the beginning stages of program implementation

Social contact referral means that an eligible individual can be referred into a RNP without waiting for the moment of potential arrest... People who enter RNP via social contact referrals should be consistent with the target population who enter through arrest diversion.

Field-Based Engagement

The program is intended to reach and engage individuals who are not actively seeking care in medical or behavioral health treatment facilities.

These standards recognize that there may be no movement past field engagement for some time, and protracted field engagement may be needed. In addition, the level of services required will often focus less on drug use issues than on other needs, and this may continue for months or years—and that is still recovery/engagement work.

Initial Interaction

To limit the coercive nature of formal signing of documents, the request for release of information should only be completed after there has been an established trusting relationship built. Once there is a sign of readiness then this Release of Information (ROI) process can be implemented.

Time Limit

There will be no fixed time limit for participation in the RNP. This will remove barriers which prevent individuals from engaging multiple times along the trajectory of their recovery. RNP programs are not crisis programs or transactional short- term interventions. Case management time and program intake volume will initially face constraints during the implementation phase. However, this model always allows a person to access the support they need to re-establish services and connection, no matter how long it takes and regardless of how many times the person needs to re-connect.