MANCHESTER, NH – The contract between GateHouse Treatment and the city, originally intended to move people from homelessness into drug detox and rehabilitation through street outreach, was terminated by GateHouse, effective Dec. 1.
Now the city is looking at other opportunities to continue with focused street outreach and other ways to help people who are homeless due to addiction and help them find recovery and stability.
The contract with GateHouse was severed via a letter sent to Adrienne Beloin, the city’s Director of Housing Stability, from GateHouse CEO Dr. Ted Bender, who joined GateHouse Treatment in September. He cited insufficient staffing as the reason they could no longer execute the terms of the contract.
Wrote Bender:
“The decision to step back from this project was not made lightly. Over the course of our involvement, the project encountered several external challenges, which inevitably affected the delivery of the intended level of service. Primarily, the intense and often traumatic nature of working directly on the streets with individuals facing severe addiction has taken a considerable toll on our team. Recently, the two primary staff members dedicated to this outreach have resigned, citing the extreme emotional and psychological strain of the work environment. Their departure has left us without the necessary personnel to effectively and safely continue this operation and we do not believe that it is a reasonable expectation that we can replace these staff members any time in the near future.”
Since the GateHouse program was initiated in March of 2023, Beloin reported to the Board of Aldermen that 90 individuals with substance abuse disorder were moved into detox. Following detox, 19 of those individuals continued to be in treatment at various levels of care and 29 found their way to a housing solution. The status of 42 of the participants (46%) was not known.
Beloin acknowledged that the scope of the project was ambitious from the start, and the vital aspect of data collection and analysis was part of the ongoing quest to improve on the program.
GateHouse committed to dedicating resources including four outreach workers who would also be responsible for data collection. Over the course of the first six months adjustments were made reducing that number to two, and when the contract was amended in September, it was to shift the program from two outreach workers to one, with a second person focused on data points that would serve as proof of concept to the city that people were, in fact, achieving and maintaining sobriety through GateHouse’s network, rather than moving through a revolving door of street to detox and back to the street.
“GateHouse was unable to deliver the basic required data collection during round one. That’s when their vice president of clinical outreach became involved and was going to manage that aspect of the contract,” Beloin said.
However, before the second contract was signed GateHouse experienced more staffing issues.
Amanda Robichaud, who originally brought the GateHouse proposal before the board in early 2023, resigned from the company. Then a third person, working in compliance for GateHouse remotely from Texas, was going to be the liaison with the city while one GateHouse employee continued doing street outreach. But then that outreach person also resigned in November, prompting Bender to sever the contract for lack of staff.
The way forward
Data collection in the recovery space is essential when it comes to accountability, says Beloin.
“Any clinical program doing outreach, connection to treatment, case management in recovery or detox, any company or program is held to these same standards based on statewide licensing standards for Substance Use Disorder,” Beloin said.
In conversation with Bender, he agreed that the data collection and reporting standards needed improving and that was the goal for the most recent review period.
In his letter Bender expressed regret that GateHouse was “unable to fulfill our commitment at this time,” adding that the decision was circumstantial and in no way reflected “dissatisfaction with the project or its management.”
Beloin is scheduled to meet with local providers in the coming weeks to discuss ways to continue street outreach and utilization of local detox programs.
One such provider is Farnum Center.
Kathy Kuhn, Chief Operating Officer of Programs for Easter Seals, the umbrella organization under which Farnum Center operates, said a meeting is set for Dec. 14 to begin that conversation with the city.
“Absolutely we are very interested in partnering with the city – we have worked with the city in the past and there are always ways we can improve the partnership. The reality is there are local beds available for detox,” Kuhn said.
She believes the GateHouse model was a good one and that outreach is essential in combating the issue of addiction and homelessness. The first step is getting someone past the fear of changing their life. The habit they know – and the fear of what it will be like physically to detoxify their bodies of alcohol or opiates is part of the need for outreach; building relationships and trust with those in need is essential.
“I agree with GateHouse that outreach is a very important component of success – and we’ve talked about it as an agency. If we were able to have resources to support more outreach we’d absolutely want to hire a team of outreach workers specifically focused on this. I think GateHouse’s approach was good, they had the right idea. It’s about making those connections, and because we have the beds available, that’s something we’re interested in thinking about further,” Kuhn said.
Local Detox Beds Available
With changes in Medicaid reimbursement earlier this year, providers are more able to meet the needs of those seeking detox and recovery services, says Kuhn.
“It has made things better for providers. The Medicaid rate has never been sufficient, but the increase in rate has had a big impact in achieving sustainability for all providers in this space,” Kuhn said.
“And while the rates still aren’t where they need to be they’re moving in the right direction. I’m glad the state is recognizing the rates are insufficient and those who are on Medicaid or uninsured have financial barriers to services,” Kuhn said.
Farnum hasn’t been at a point of full capacity for its detox beds in years, says Kuhn.
“With detox one thing that is tricky and which people don’t often understand, is there’s a very specific eligibility criteria to access medical detox services and they’re fairly limited in terms of who can access those services. There are some who think they need that medical support to withdraw from whatever they’re withdrawing from, but unless they meet that criteria they’re not medically eligible for a medical detox,” says Kuhn.
“So what we’ve done is we will bring you into medical detox as long as there are beds available so that you have the support you need to be able to safely and comfortably – as possible – withdraw. We’ve made that change in our programming to combat what is a slowness to respond from the field,” says Kuhn.
She explains that current criteria set by the American Society for Addictive Medicine (ASAM) is not keeping up with what’s being seen by those working in the trenches with people seeking recovery.
“ I feel – and the state would agree – that we need to broaden that criteria for medical detox so we can serve more people so they feel comfortable coming in for help,” Kuhn said.
The current ASAM criteria assesses a patient on the following standards:
- Acute intoxication and/or withdrawal potential
- Biomedical conditions and complications
- Emotional, behavioral, and cognitive conditions and complications
- Readiness to change
- Relapse, continued use, or continued problem potential
- Recovery/living environment
Keeping it Local
Beloin says under the GateHouse contract it was agreed that local detox beds would be sought before sending someone from the streets of Manchester to a detox in Massachusetts. A perk of the GateHouse arrangement was their relationship with Sunrise Detox, a private recovery center in Millbury, Mass., where they could guarantee placement.
In her memo to Aldermen about the GateHouse contract ending, Beloin said that she was committed to finding solutions to access to treatment, including the commitment to local detox options.
Of the $500,000 the city allocated for the contract with Gatehouse, about half of it remains, Beloin said. It could be used to send people to access detox treatment at Sunrise using Beloin’s staff as liaisons, or outside partners.
Potentially, there’s consideration for other local solutions where those funds could help overcome insurance barriers and that’s what Beloin is exploring with the local partners.
“I commend GateHouse for putting forth the idea that private funds can be used, and I’ve since talked to the folks at Sunrise and they’re willing to work directly with us, so should we come up with folks who can benefit from treatment at Sunrise, we can send them there. But we’re also seeking out local treatment providers doing outreach and who have beds in New Hampshire who are willing to work with us. We’re also talking to the Doorways to determine what the barriers are that remain, whether it is insurance or otherwise,” Beloin said.
Another local provider is Live Free Recovery. Ryan Gagne has been in the recovery space since 2009 and has learned a lot about what works – and what works better.
“Live Free Recovery started as Live Free Sober Living in 2015 as the first – and I use this term loosely, but – ‘legal’ sober living home. By that I mean we went through the rezoning process with the city and Manchester Fire Department, and were allowed under Chief Goonan to utilize the location at 70 Kelley Street.
Although the Kelley Street house has been under lease with another organization, it is coming back to Live Free in the new year, says Gagne.
They also have women-only outpatient and supportive housing programs in Manchester, as well as detox, residential and outpatient programs in Keene.
“We started offering clinical services in 2020 to fill the gap in services for Medicaid. I’ve worked in private treatment and over the years found in that space you’re really only serving 1-3 percent of the population in need. And after being on that side of the treatment industry, it took a while before I realized it’s not where I come from – and I’m someone in long-term recovery myself. Our goal was to find a way to really serve the population in need here in Manchester,” Gagne said.
He has developed what he considers a financially sound and sustainable model and is open to going deeper with the city in whatever capacity he might be able to serve,” Gagne says.
Although the city’s contract with GateHouse was innovative and ambitious – and not without its hurdles, it is also a “learning moment” to build on, Gagne says.
“We do a lot of this already on a smaller scale, in terms of working with community partners to help clients in need and navigating certain continuums of care. Whenever there’s any success in this work, it’s rooted in some type of failure – or better, a learning moment. Typically every time you try something and you have the guts to try, you get closer to a permanent solution. In this case, the thing you have the guts to do can actually save a life,” Gagne says. “There is potential to make a positive change right now, not just for the city but as a pathway for others to learn how to navigate this, and we’re here to try to help.”