In 2011, the National Alliance for Recovery Residences (NARR) established national standards for recovery residences (including sober housing). These standards were developed using a collaborative approach with input from regional and national recovery housing organizations. MASH is an affiliate of NARR and used these standards to create Massachusetts standards for certified sober homes. NARR has since released two updates to the standards, first in October 2015 and then in 2018. The third version of the NARR standards provides more explicit guidance to providers, including metrics for evaluating the peer support components of a residence’s recovery environment.
In Massachusetts, sober homes and recovery residences are different models for substance abuse recovery. Recovery residences — formerly known as halfway houses — are licensed residential treatment programs, while Massachusetts sober homes are peer-led and do not provide treatment. Sober homes provide mutual support, emphasize independent living skills, and depend on peer leadership. They are not licensed and are not funded by the state.
Administrative Domain
Core Principle: Operate with Integrity
1.1 A written mission statement that corresponds with NARR's core principles
1.2 A vision statement that corresponds with NARR's core principles as stated in this document
2.a. Documentation of legal business entity (e.g. incorporation, LLC documents or business license).
2.b. Documentation that the owner/operator has current liability coverage and other insurance appropriate to the level of support.
2.c. Written permission from the property owner of record (if the owner is other than the recovery residence operator) to operate a recovery residence on the property.
2.d. A statement attesting to compliance with nondiscriminatory state and federal requirements.
2.e. Operator attests that claims made in marketing materials and advertising will be honest and substantiated and that it does not employ any of the following:
- False or misleading statements or unfounded claims or exaggerations;
- Testimonials that do not reflect the real opinion of the involved individual;
- Price claims that are misleading;
- Therapeutic strategies for which licensure and/or counseling certifications are required but not applicable at the site;
- or Misleading representation of outcomes.
2.f. Policy and procedures that ensure the following conditions are met if the residence provider employs, contracts with or enters into a paid work agreement with residents:
- Paid work arrangements are completely voluntary.
- Residents do not suffer consequences for declining work.
- Residents who accept paid work are not treated more favorably than residents who do not.
- All qualified residents are given equal opportunity for available work.
- Paid work for the operator or staff does not impair participating residents’ progress towards their recovery goals.
- The paid work is treated the same as any other employment situation.
- Wages are commensurate with marketplace value and at least minimum wage.
- The arrangements are viewed by a majority of the residents as fair.
- Paid work does not confer special privileges on residents doing the work.
- Work relationships do not negatively affect the recovery environment or morale of the home.
- Unsatisfactory work relationships are terminated without recriminations that can impair recovery.
2.g Policy and procedure that ensures refunds consistent with the terms of a resident agreement are provided within 10 business days, and preferably upon departure from the home
2.h. Staff must never become involved in residents’ personal financial affairs, including lending or borrowing money, or other transactions involving property or services, except that the operator may make agreements with residents with respect to payment of fees.
2.i. A policy and practice that provider has a code of ethics that is aligned with the NARR code of ethics. There is evidence that this document is read and signed by all those associated with the operation of the recovery residence, to include owners, operators, staff and volunteers.
2.j. Policy and procedures that ensure all residents are age eighteen or older at time of admission.
3.a. Prior to the initial acceptance of any funds, the operator must inform applicants of all fees and charges for which they will be, or could potentially be, responsible. This information needs to be in writing and signed by the applicant.
3.b. Use of an accounting system which documents all resident financial transactions such as fees, payments and deposits.
- Ability to produce clear statements of a resident’s financial dealings with the operator within reasonable timeframes.
- Accurate recording of all resident charges and payments.
- Payments made by 3rd party payers are noted.
3.c. A policy and practice documenting that a resident is fully informed regarding refund policies prior to the individual entering into a binding agreement.
3.d. A policy and practice that residents be informed of payments from 3rd party payers for any fees paid on their behalf.
4.a. Policies and procedures regarding collection of resident’s information. At a minimum data collection will
- protect individual’s identity.
- be used for continuous quality improvement and
- be part of day-to-day operations and regularly reviewed by staff and residents (where appropriate).
Core Principle: Uphold Residents’ Rights
5.a. Documentation of a process that requires a written agreement prior to committing to terms that includes the following:
Resident rights
Financial obligations, and agreements
Services provided
Recovery goals
Relapse policies
Policies regarding removal of personal property left in the residence
6.a. Policies and procedures that keep residents’ records secure, with access limited to authorized staff.
Core Principle: Create a culture of empowerment where residents engage in governance and leadership
7.a. Grievance policy and procedures, including the right to take grievances that are not resolved by the house leadership to the operation’s oversight organization for mediation
7.b. Grievance policy and procedures, including the right to take unresolved grievances to the operator’s oversight organization
7.c. Verification that written resident’s rights and requirements (e.g. residence rules and grievance process) are posted or otherwise available in common areas.
7.d. Policies and procedures that promote resident-driven length of stay.
7.e. Evidence that residents have opportunities to be heard in the governance of the residence; however, decision making remains with the operator.
8.a. Peer support interactions among residents are facilitated to expand responsibilities for personal and community recovery.
8.b. Written responsibilities, role descriptions, guidelines and/or feedback for residence leaders.
8.c. Evidence that residents’ recovery progress and challenges are recognized and strengths are celebrated.
8.d. Policies and procedures that defend residents’ fair housing rights
Core Principle: Develop Staff Abilities to Apply the Social Model
9.a. Evidence that management supports staff members maintaining self-care.
9.b. Evidence that staff are supported in maintaining appropriate boundaries according to a code of conduct.
9.c. Evidence that staff are encouraged to have a network of support.
9.d.Evidence that staff are expected to model genuineness, empathy, respect, support and unconditional positive regard
10.a Policies that value individuals chosen for leadership roles who are versed and trained in the Social Model of recovery and best practices of the profession.
Job descriptions require staff to facilitate access to local community-based resources.
11.a. Policies and procedures that serve the priority population, which at a minimum include persons in recovery from substance use but may also include other demographic criteria.
11.b. Cultural responsiveness and competence training or certification are provided.
12.a. Job descriptions include position responsibilities and certification/licensure and/or lived experience credential requirements.
12.b. A resident council or process is in place that ensures resident’s voices can be heard
12.c. Job descriptions include staff responsibilities, eligibility, and knowledge, skills and abilities needed to deliver services. Ideally, eligibility to deliver services includes lived experience recovering from substance use disorders and the ability to reflect recovery principles.
13.a. Policies and procedures for ongoing performance development of staff appropriate to staff roles and residence level.
13.b. Evidence that supervisors (including top management) create a positive, productive work environment for staff.
Physical Environment Domain
Core Principle: Provide a Home-like Environment: The residence is comfortable, inviting, and meets residents’ needs
14.a. Verification that the residence is in good repair, clean, and well maintained
14.b. Verification that furnishings are typical of those in single family homes or apartments as opposed to institutional settings.
14.c. Verification that entrances and exits are home‐like vs.institutional or clinical.
14.d. Verification of 70+ sq. feet for the first bed and 50+ sq. feet per additional bed.
14.e. Verification that there are bathroom ratios of 8:1 for women’s and 10:1 for men’s
14.f. Verification that each resident has personal item storage.
14.g. Verification that each resident has food storage space.
14.h. Verification that laundry services are accessible to all residents.
14.i. Verification that all appliances are in safe, working condition.
15.a. Verification that a meeting space is large enough to accommodate all residents.
15.b. Verification that a comfortable group area provides space for small group activities and socializing
15.c. Verification that kitchen and dining area(s) are large enough to accommodate all residents sharing meals together.
15.d. Verification that entertainment or recreational areas and/or furnishings promoting social engagement are provided.
Core Principle: Promote a Safe and Healthy Environment
16.a. Policy prohibits the use of alcohol and/or illicit drug use or seeking.
16.b. Policy lists prohibited items and states procedures for associated searches by staff
16.c. Policy and procedures for drug screening and/or toxicology protocols.
16.d. Policy and procedures that address residents’ prescription and non-prescription medication usage and storage consistent with the residence’s level and with relevant state law.
16.e. Policies and procedures that encourage residents to take responsibility for their own and other residents’ safety and health.
Note: “The MassHealth agency does not pay for the following services: […] (4) tests performed only for purposes of civil, criminal, administrative, or social service agency investigations, proceedings, or monitoring activities; (5) tests performed for residential monitoring purposes; […] (9) test that are not medically necessary as defined in 130 CMR 450.204: Medical Necessity; …”130 CMR 401.411: Noncovered Services and Payment Limitations.
17.a. Operator will attest that electrical, mechanical, and structural components of the property are functional and free of fire and safety hazards.
17.b. Operator will attest that the residence meets local health and safety codes appropriate to the type of occupancy (e.g. single family or other) OR provide documentation from a government agency or credentialed inspector attesting to the property meeting health and safety standards.
17.c. Verification that the residence has a safety inspection policy requiring periodic verification of
- Functional smoke detectors in all bedroom spaces and elsewhere as code demands,
- Functional carbon monoxide detectors, if residence has gas HVAC, hot water or appliances
- Functional fire extinguishers placed in plain sight and/or clearly marked locations,
- Regular, documented inspections of smoke detectors, carbon monoxide detectors and fire extinguishers,
- Fire and other emergency evacuation drills take place regularly and are documented (not required for Level I Residences).
18.a. Policy regarding smoke‐free living environment and/or designated smoking area outside of the residence.
18.b Policy regarding exposure to bodily fluids and contagious disease.
19.a Verification that emergency numbers, procedures (including overdose and other emergency responses) and evacuation maps are posted in conspicuous locations.
19.b. Documentation that emergency contact information is collected from residents.
19.c. Documentation that residents are oriented to emergency procedures.
19.d. Verification that Naloxone is accessible at each location, and appropriate individuals are knowledgeable and trained in its use.
Recovery Support Domain
Core Principle: Facilitate Active Recovery and Recovery Community Engagement
20.a. Documentation that residents are encouraged to do at least one of the following:
- Work, go to school, or volunteer outside of the residence (Level 1, 2 and some 3s)
- Participate in mutual aid or caregiving (All Levels)
- Participate in social, physical or creative activities (All Levels)
- Participate in daily or weekly community activities (All Levels)
- Participate in daily or weekly programming (Level 3’s and 4’s)
21.a. Evidence that each resident develops and participates in individualized recovery planning that includes an exit plan/strategy
21.b. Evidence that residents increase recovery capital through such things as recovery support and community service, work/employment, etc.
21.c. Written criteria and guidelines explain expectations for peer leadership and mentoring roles.
22.a. Resource directories, written or electronic, are made available to residents.
22.b. Staff and/or resident leaders educate residents about local community-based resources.
23.a. A weekly schedule details recovery support services, events and activities.
23.b. Evidence that resident-to resident peer support is facilitated:
- Evidence that residents are taught to think of themselves as peer supporters for others in recovery
- Evidence that residents are encouraged to practice peer support interactions with other residents.
24.a. Provide structured scheduled, curriculum-driven, and/or otherwise defined support services and life skills development. Trained staff (peer and clinical) provide learning opportunities.
24.b Ongoing performance support and training are provided for staff.
25.a. Evidence that the program’s weekly schedule includes clinical
Core Principle: Model Prosocial Behaviors and Relationship Enhancement Skills
26.a. Evidence that staff and residents model genuineness, empathy and positive regard
26.b Evidence that mechanisms exist for residents to inform and help guide operations and advocate for community-building.
Core Principle: Cultivate the Resident’s Sense of Belonging and Responsibility for Community
27.a. Residents are involved in food preparation.
27.b. Residents have a voice in determining with whom they live.
27.c. Residents help maintain and clean the home (chores, etc.).
27.d. Residents share in household expenses
27.e. Community or residence meetings are held at least once a week.
27.f. Residents have access to common areas of the home.
28.a. Engagement in informal activities is encouraged.
28.b. Community gatherings, recreational events and/or other social activities occur periodically.
28.c. Transition (e.g. entry, phase movement and exit) rituals promote residents’ sense of belonging and confer progressive status and increasing opportunities within the recovery living environment and community.
29.a. Residents are linked to mutual aid, recovery activities and recovery advocacy opportunities.
29.b Residents find and sustain relationships with one or more recovery mentors or mutual aid sponsors.
29.c Residents attend mutual aid meetings or equivalent support services in the community.
29.d Documentation that residents are formally linked with the community such as job search, education, family services, health and/or housing programs.
29.e Documentation that resident and staff engage in community relations and interactions to promote kinship with other recovery communities and goodwill for recovery services.
29.f Residents are encouraged to sustain relationships inside the residence and with others in the external recovery community
30.a Preemptive policies address common complaints regarding at least:
- Smoking
- Loitering
- Lewd or offensive language
- Cleanliness of the property
30.b. Parking courtesy rules are documented.