Vermont Legislature SmartTranscripts:

[Representative Theresa Wood (Chair)]: Okay, welcome back, folks. We are now going to take up S-one 157. We are moving topics to an act relating to recovery residence certification. This is a bill we're going to be hearing from the field. We're going to be hearing from the Department of Health of substance use disorders. And we are getting some assistance to have Testimonique from folks with lived experience that we will get next week. So I'm going to start off with the department. And Emily, welcome. And there are people in the room that haven't been in the room this year yet, so especially a special guest. So we're going to go around the room and just do brief introductions. So my name is Theresa Wood. I'm from Waterbury, and I also serve Bolton, Buloscore, and Huntington.

[Representative Daniel Noyes (Clerk)]: Hi. I'm Dan Noyes. I represent Wilkett, Hyde Park, Johnson, Belvieu.

[Representative Eric Maguire]: Hi. I'm Aaron B. Bligh, represent Rockwood City. I'm Doug Bishop, and I'm poststructure here in Philadelphia. I Doug live in Guildford and also represent Vernon.

[Representative Theresa Wood (Chair)]: Hello, I'm Esme Cole of Hartford. Thank you, I'm Jubilee McGill, and

[Representative Jubilee McGill]: I represent Bridgeport, Middlebury, New Haven, and

[Representative Theresa Wood (Chair)]: Wey I am one of the nicest. I'm the Reggerofano, Esme Cole, I'm

[Representative Jubilee McGill]: I'm here in prayer. Great folks, action syllables.

[Gregory Tatro (Co-Founder, Jenna's Promise)]: I'm Gregory Petrow, co founder of Janice Promise, and here with my son, Aisin Petrow. This is Marissa, so many years.

[Representative Theresa Wood (Chair)]: Welcome. Thanks.

[Chad Vige (CEO, Recovery House, Inc.)]: Chad B. J, CEO of Recovery On Sync.

[Representative Jubilee McGill]: Jessica Schpano, Policy Director, Department of Health.

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: And Emily. Good morning. My name is Emily Trudder. I am the division director for the Health Department's Division of Substance Use Programs. And I'm happy to be here. I apologize, I'm getting my new prescription right after this. I'm very close to my paper, and I apologize for ahead of time. That's okay. I'm excited to be here this morning on behalf of the department and in partnership with numerous of our community partners to talk about the recovery of our residents field. You'll note at the bottom of our presentation, we have a tenant that we sort of live by that prevention works, treatment is effective, and people recover. So, we're going focus a lot today on people recover. In that space, we have a strong network of recovery residences across the state supporting Vermonters, but we know that we have a need. Over the last year and a half, we have published a community informed needs assessment, as well as our new strategic plan, in that the core focus is around access to services and programming. So this bill, in many respects, helps facilitate that process and helps us get closer to achieving those goals. The s one fifty seven is an essential component of that movement and movement forward in in enhancing our network to support increased capacity and the quality of services and programming that we provide. S one fifty seven also makes the landlord tenant exclusion permanent, allowing individuals who are residing in these programs as well as the staff there to remain safe in the recovery residence and environment along with fostering environments to support the recovery, ensure support recovery. Today, I'm going to show a little bit more about our landscape. And then for the purposes of time, since a lot of other partners here today, to the chase and talk about the bill itself. The next slide is an image just because we do names make all the difference in recovery, the little r versus the capital R. For example, you have Recovery House here today with us today with Chavijay. It's a treatment program. We're talking today about recovery residences, but we also have recovery centers. So we just want to make sure you have a definition in front of you that might be a little helpful with that. Today, we're talking about the middle piece, which is recovery residences. In that space, we, as the state of Vermont, did adopt the National Alliance of Recovery Residences Standards. Jeff Moreau is with us today from VTAR, that is Vermont's affiliate, as part

[Representative Theresa Wood (Chair)]: of that. I'd like to ask you a question. Sure. When you say we adopted, so we knew from VTAR, from testimony on this bill, on previous bill a couple of years ago. When you say we adopted, did you did you make a policy decision at BDH? Or are you just saying we, meaning the field has adopted it? I would say it's both. I would say numerous states have adopted the NARA standards as part of that. When I've been with the division since 1994.

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: There was a time this was a very organic, grassroots type of space. As part of our modeling, we're always looking for evidence based practice. We're looking for consistent definitions, making sure we have quality measures in this met that moment. So NAR is a you'll hear numerous states talk about NAR standards. And we, Lamoille, chose to dive in. Okay. And are you I haven't looked ahead to the rest of your are you gonna speak to sort of the

[Representative Theresa Wood (Chair)]: well, when we get to the bill, I'll ask when we get to the bill. Never mind. Okay. Go ahead. Okay.

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: I do wanna give a definition of what a recovery residence is. A recovery residence means a shared living residence supporting individuals recovering from a substance use disorder that provides residents with peer support, assistance accessing support services, and community resources for individuals recovering from substance use disorder. There are four levels of recovery residences under the NAR standards, so levels one through four. In the state of Vermont, we currently have, funded by the department, level twos and level threes. And I'll talk about those for a second. There are level ones in the state that operate independently. They're completely peer run. But we don't currently have any oversight in that space. So level one is entirely peer run. The house takes care of itself, essentially. They've come together as a group of individuals to work towards their recovery goals. A level two, which is the main portion of the recovery residences that we currently fund across the state is a managed environment with house rules and designated leaders, sometimes including offerings of, for example, pure run throughs. Level three, we do have some level three residences in the state of Vermont. Gregory is here today from one of them. It's a supervised environment that has staffing and life skills as part of that. And then the NAR definition of level four offers clinical services.

[Representative Daniel Noyes (Clerk)]: Yeah, go ahead. On level one, you said that you don't get involved with those, but

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: They tend to be autonomous by nature. So Oxford Houses, I don't know if anybody's heard of that. There is one in Burlington currently. Are different states have different mixes of I recently heard a presentation. Alabama, for example, has a very large Oxford House model and implementation. A group of individuals have come together and chosen to live in that environment and support each other through their recovery, but that tends to be more of an autonomous space.

[Representative Daniel Noyes (Clerk)]: But you don't provide any supports or any input for them?

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: Currently, no.

[Representative Daniel Noyes (Clerk)]: When we What do level

[Representative Theresa Wood (Chair)]: up on? We do not. Okay, thanks for my question. So when we, in the budget, we've passed money for continued development of recovery residences and we're talking at levels above level one.

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: Yes, so right now, yes,

[Representative Theresa Wood (Chair)]: two and three is our primary focus at the bottom. Okay. Go ahead, representative.

[Representative Todd Nielsen]: Should we have level fours? And if so, what's the decision making on not funding those?

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: We don't currently have level fours right now. We have been focused in the treatment landscape in the 3.1 level of care. So right now, Jubilee is with us here today from Recovery House. That is a residential space with a much longer length of stay that has clinical services on premises. But they go and travel out to their community to engage in different activities, whether it be work, life skills, volunteering, other things. So in many respects, we've been focused in that area of the 3.1. We recently had a facility open in for gens, 27 beds through Valley Vista. So that's sort of where we've been tackling that need.

[Representative Theresa Wood (Chair)]: And The space that you're talking about now, Emily, is that the space that the judge has been concerned about? The three point ones? Yeah. Yes. Okay. Yes. Judge Rice. Yes. I was trying to pronounce her name, but

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: We've made some positive traction. We have two locations under the Serenity House umbrella, and then we have the three point one is now open in Virgin's.

[Representative Theresa Wood (Chair)]: Thank you. And I recognize that in these conversations we've had over the last couple of years with the Judge Rice, is that her name? Yeah. She had brought together a number of folks across HS and in the court system and really had identified in the Our previous commissioner had, yes, agreed that we had space to improve there in terms of that was a missing element in our system, missing capacity element in our system. So I had heard earlier about Valley Vista opening space there too and, of course, move that space. So thank you for continuing that work. And that group continues to meet. We literally just met this past Monday,

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: so that work continues in partnership. And the last meeting did have a large focus on recovery housing, so this is all very timely. The next phase we want to talk about is there were a couple of legislative reports that were required as of last session. So right now, part of that was to do an inventory and ask some particular questions. So the data on this slide, it says eight organizations, 29 locations, 145 beds with an asterisk. That was as of October 2025 when we published the report. Since then, Vermont Foundation of Recovery has opened new beds in Essex, so we are now at 155. So just want to make sure that that was clear, but we didn't want the presentation not to dovetail the report. When you receive the, which I think you may have already, the PowerPoint electronically, it does have the links to the reports if you would like to take a deeper dive. We do, again, want to acknowledge our partners at VITAR and NAR as part of the important work that happens here. I'm not going to steal Jeff's thunder. So Jeff is here. So I will let Jeff talk about the wonderful work that he does in regards to certification and supporting this network at large, and that they are a critical component of the work that he did. Let's see here. So the Act 163, Section two recommendations of the report that we were required to submit had some key areas to focus on. The first being address the areas to expanding capacity. Again, that ties beautifully with our strategic plan. We'll talk about rural health transformation a little bit later in the slide deck. Address gaps in Vermont's recovery residential landscapes. That also includes making sure that we expand our level two and level three capacity across the state. In the report itself, you'll see a map. So for example, one thing that we want to do is make sure we have services located in all counties. We do not currently have that at the moment. We currently do not have it in Addison, Essex, Grand Isle, Orange, Orleans, and Windham. And we're also looking to focus on specific populations, such as couples, women, individuals with children, and individuals with pets as part of the work that we do there. Right now, our capacity is about fiftyfifty as far as beds for men and women across the state, a little bit more of a tip towards women with the opening up

[Representative Theresa Wood (Chair)]: to beds in Essex. I'm just wondering, Emily, we hear a lot and see the data from the Department for Children and Families on the number of people who are homeless who have a substance use disorder. And what is the work that happens between BDH and DCF around trying to facilitate access for those individuals to treatment?

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: We have a very large work group that convenes weekly at the AHS level that includes all partners across the department. So ourselves, DCF, the Department of Mental Health, Dale. So it's a cooperative group in that. One area that we're partnering in particular is on recovery shelters. One just recently opened in the Burlington area as part of that. So there is regular communications. We're also working together on a plan. We received financial support for outreach and engagement workers as part of the opioid abatement settlement. How can we work together with BCCI and other programming to really help in that space to get out into the community? We right now have positions in all of our preferred provider treatment providers. So there's 26 positions that we have funding for across the state. So we're looking to coordinate our outreach work as part of that to get individuals into the appropriate spaces and facilitate engagement. So it's very active. So when you

[Representative Theresa Wood (Chair)]: say looking to get out into the community, do you actually go to places where people Yes. To require homelessness? Thank you. You're welcome.

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: The additional pieces in the Act 163 report included amending the landlord tenant statute to ensure that certified recovery residents operators are able to effectively maintain safe and supportive environment for individuals entering the program, the full resident complement, as well as individuals working in these programs. And a big piece of that was also to support data collection. We all know I'm a government employee. I have been my entire adult life. Administrative burden and bureaucracy are a thing as part of that. So trying to consolidate right now, we have data collection expectations for the health department because of grants management and other expectations, as well as what's being collected through VTAR. We're looking to harmonize those two efforts to really get down to what effective data collection systems could look like and having a consistent expectation of processes. Next, I'm going to move on to one of the truly exciting things that are out there right now, rural health transformation. As part of that very large initiative, there was a funding carve out for recovery residences specifically. We currently have a live RFP out there for Level 2 and Level 3 residences that we're excited about. The RFP closes at the April. April's a good month. This is Alcohol Awareness Month for anybody who's not aware. Our One Last Campaign is out there. Please feel free to take a watch. But right now, the goal of that particular funding is, number one, to access to services, so expand capacity across the state and address some of those gap areas and some of those gap populations. We are looking at workforce components and training and technical assistance, data collection and supporting the certification space. And in general, it can support base operations of recovery residents themselves.

[Representative Theresa Wood (Chair)]: You spoke a few minutes ago about the places where the goal is to have at least one in every county. So when you put out an RFP, are you putting it out specific? I haven't clicked the link. I was trying to look for the verb. I haven't clicked the link. But are you looking for people to directly respond to those areas?

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: It is part of the RFP itself. I have to be a little careful. There are two potential applicants in the room as part of the RFP itself and it's a competitive RFP. But yes, it speaks specifically to they are required in their submissions should they choose to apply to address geographic location and by the justification for why that is.

[Representative Theresa Wood (Chair)]: Okay. Well, I guess that's when you say address geographic location, does the RFP specifically say we are looking for homes in these five counties or whichever, however minute you just

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: It doesn't say it specifically, because even in the areas where we have them, we don't have enough. And there is, in my opinion, enough funding to cover it all, to be quite honest. So this is a very large investment. It more than doubles the current budget for recovery residences in the state of Vermont. So I think that you're going to see in both places, you have population centers that may have it, but they don't have enough. We clearly have gap years where there's none, and that needs to happen. And what's interesting about recovery residences is is way individuals choose to engage it. They may choose to engage in recovery residences in community in which they reside. It may also not be healthy necessarily for them. They may need to go somewhere else and decouple themselves from that. So statewideness is very important to us. In regards to recovery residences, there's also a component of making sure that the community, where it's physically located, the community around it can support the activities they're going to do. So there's a variety of pieces that happen. It will no matter what, we will always address the gap areas as part of that RFP.

[Representative Theresa Wood (Chair)]: So for the people in the room who might be applying.

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: They both attended the bidders conference.

[Representative Theresa Wood (Chair)]: That

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: would be my priority. Okay, thank you. You're welcome. So next we would like to talk about the bill itself. So the health department supports S-one 157, in general, as passed by the Senate. It grants authority to the Department of Health to establish and oversee a certification process for recovery residences. We would go through the rulemaking process as part of that. We highly value community engagement as part of that process as we build those rules and expectations. It requires the Department of Health to establish a data collection standard and reporting requirements for certified recovery residences. And again, I think that that's mutually beneficial from an administrative burden component and also as we track the utilization and movement of the programming and eventual outcomes. We like that it would make the exclusion for certified recovery residences from the landlord tenant law permanent. One thing that's really great about that, by adding that carrot, that incentive for certification, by making it so that certified recovery residences are the ones that are able to employ that exemption. We think it's an important piece of the work here. The certification in and of itself offers a baseline level of quality and comprehensive programming.

[Representative Theresa Wood (Chair)]: Well, I saying that right now, you realize. Yes. That would be our preference. Yeah, that's fair. I'm sure it'd be You probably will see some changes. Let's just put it that way. Thank you.

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: And then just on the last slide here, we just want to give you a vision for the future. We are very much focused on where do we see ourselves in 2030. We're doing that across the continuum of care. That slide opens, again, with what is in the Act 163 report, again, with that caveat for the new beds, and then where we envision the future. To be quite honest, you know, rural health transformation is not contingent upon the passage of this bill, but that this bill plus that is can take us to an exponential place and do some really wonderful things across the state of Vermont as we seek to expand. You know, one of the goals of Medicaid and other places is statewide, making sure that every homeowner has access to the same level of service. I'm like, is there a map right now? There is a map in the report and I apologize that I don't have it on

[Representative Theresa Wood (Chair)]: my report. In report. Yes. Thank you. The link is on our website. Yeah. Thank you. So I'll ask my question now that I was gonna ask previously since you said that the department is interested in having the authority to establish and oversee the certification process. So that's a change from two years ago. And so I guess I'm interested in what's been the evolution of the thinking at the health department around that, because it was definitely not a place that people wanted to go to two years ago when we passed the bill, the previous bill. Honestly, a

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: little bit from my personal perspective.

[Representative Theresa Wood (Chair)]: Which I appreciate because you've been there a while, so that's Yes.

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: I've grown up in the division of substance use programs. And I'd be able to see it every iteration of itself. I would say coming out of COVID, being part of the Department of Health, capacity was an issue at one point in time. The federal government, the Substance Abuse and Mental Health Services Administration, provided two funding sources as we came out of COVID. One tied to the COVID supplement, which sort of helped us evolve out of that, and then also the American ARPA ARPA's rescue plan. Yes, thank you. As part of that, they helped kick start us into this new world and new space. To be quite honest, the services and needs did evolve quite a bit post pandemic. So as we look at the needs of individuals, which in my opinion have become more acute, just the world around us in general, we've moved away from that and we're in a space right now in our staffing pattern to dive in. And I think that this would be similar to what's happening right now recovery services world. We recently have a peer recovery support specialist certification that just came as part of that, that is now facilitated through OPR. We're working right now on RCO, so Recovery Certified Recovery Centers themselves. So some parity across the system. So we would now have it in the treatment space. We would have it in the recovery center space and the recovery residents and having a common standard across the board. And we are in a place in a position now that we can accomplish that. I appreciate that. I think

[Representative Theresa Wood (Chair)]: that one of the things that historically we have been concerned about in this committee is, think while intellectually people understood a continuum from heart reduction all the way to recovery and sort of the levels of support within that, it seemed like there were definite focuses on treatment, for instance, and the hub and spoke system And residential it felt like the recovery aspects were not as well supported or attended to. And so I just wanna extend our appreciation for that fact that things have changed and that's good. I think it's I wanna have a shout out to the industry themselves because they were sort of self regulating at the same time. But as we are putting more and more taxpayer money into that, we need to have a responsible entity within state government for assuring that taxpayer dollars are being spent like they're supposed to be. So I just am saying thank you and appreciate that.

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: And we appreciate your support in that. It's pretty incredible. There's wonderful momentum right now, and we're excited about the work in front of us.

[Representative Theresa Wood (Chair)]: Bless Great. You. Bless you. Does anybody have any further questions for Emily? Great. Good luck with your glasses. Oh, thank you very much. Okay, now we're gonna hear from some other folks, I think we have Jeff up first. Good morning, Jeff. Nice to see you again.

[Jeff Moreau (Executive Director, Vermont Alliance for Recovery Residences)]: Good morning, everyone. Thank you for the opportunity. For the record, my name is Jeff Moreau. I'm the executive director of the Vermont Alliance for Recovery Residences, otherwise known as VITAR. For the past sixteen years, I've also served as a surveyor for the Commission on Accreditation of Rehabilitation Facilities. Some might know of this as CARF. They are an international accrediting body for behavioral health and substance use disorder. I also have nearly thirty five years of experience in nonprofit work. But I have to tell you, my role with VTAR has been among the most impactful and rewarding. This has been an incredible opportunity and I'm just really pleased to be in this arena. I wanna start off this morning by thanking you Chair Wood and members of the House Committee on Human Services. It's already been alluded to this morning, but we have made incredible strides. Prior to my coming on board as referenced, there was no oversight of recovery residences. And folks like David Rey Garofalo and Peter Mallory and others brought NAR to the state of Vermont. And here we are today, we've got over 150 beds that are certified. We have this incredible opportunity with a Rural Health Transformation grant to expand that to 400 or more. And we'll talk a little bit more about it in a few minutes relative to this bill, but we are doing things as typical in Vermont, very different from other states around the country, and much for the better for those people that we serve. So again, just a huge thank you to each of you for working with us so closely and bringing us to this pivotal moment. You know, it's a little funny to say in this way, but the Rural Health Transformation funding will make a tremendous difference in the health and welfare across Vermont, but it is going to be exceptionally transformational in the recovery residents arena. The funding that is coming our way for the RFP that you spoke about, and to stand up VTAR is just overwhelming, to be honest, it's, it's so very exciting. So just by way of background, your investments have inspired operators to scale this resource. You're encouraging other operators through your funding, as well as this bill to come and do this work in Vermont. We have been able to really take advantage of the housing vouchers to help people with access to this resource. So any of the residents coming in, oftentimes they are coming from homelessness, I jotted down 58% of the folks that enter recovery residence come from homelessness. So as you can imagine, asking them to start paying immediately is a real challenge for them, and we don't want that to be a barrier. So we have funding thanks to you and the state to be able to do that. And the transformation grant will allow us more flexibility for helping people that maybe have a recurrence of their disease, lose employment, or something that we've experienced a couple times here in the last month or so, a couple of our ladies have had babies in the homes, and so just being able to support them. So that flexibility is going to be really great to see. So moving on to S157, again, the last two years have really allowed us an opportunity to test this model prove it, take data and really prove its effectiveness. And in its simplest terms, it allows for those individuals that have a recurrence of their disease, or exhibit violent or threatening situations to be temporarily removed from the home to protect the health and welfare of everybody else. And what we do different than any state under the NARA continuum is we ask residents when they come in to develop a self directed recovery plan that also identifies where they might like to go if they do experience a recurrence. So they may very well have a safe place to go, and we want to honor that. What our homes have done is they've set a second layer of what we've called respite spaces. So some might utilize an apartment, a partnership with another entity to offer that to the individual if they don't have any place to go. And I can tell you, I get a report for every single person that is temporarily removed or permanently removed, And I review those carefully and no one has been released to homelessness from a certified recovery residence in this period. And now today, and this is probably for me, the most exciting and compelling part of this bill is the establishment of stabilization beds at programs like CHADS and Valley Vista, which will serve as an ultimate safety net. If the individual has no place to go, they can utilize these beds. And again, it's not treatment, it's a place that folks can go for a day or a few days if needed to figure out what their next steps are. It may be reengaging in treatment, it may just be they had to slip up and needed a few minutes to work that through, and then they're going to return to the home, and they're getting those level of supports. And that's something that we've advocated for for almost a decade. And now it's stood up and running, which is incredibly exciting. Some of the lessons learned with this work and the reason for a little bit of expansion to these reasons for exemption to landlord tenant beyond return to use and violent and threatening situations include shoplifting. I can give you an example of two individuals that were in a program, and one of the individuals brought along another resident, And I'm beknownst to that other resident, this individual was shoplifting and both had a record and that immediately impacted this other individual. And those items that were stolen were brought back to the home. And you can imagine that, you know, that type of activity is or has that negative impact on everybody else in the home when that happens. Another example is human trafficking. We have had at least one or two cases where an individual is trafficking another individual in the home. And obviously that can't be allowed as well. There are two examples of that. The second one was it turned out that one of the residents that was being trafficked was joined by the person that trafficked that individual in the home. And so the trauma and experience of that had a real negative impact. Theft in the home of other people's items. So we have asked for a few additional things in this bill to make sure that this is working well based on that two years of experience from the operators. I'll wrap up by saying two really important things for your consideration. I know some of you have heard from the head of NAR this last fall that, you know, operators across the country, they deal with landlord tenant law, and it just, it is what it is. And that wasn't a completely accurate statement. First and foremost, I think arguably Vermont has some of the most trenchant landlord tenant laws across the country, which is important. But more importantly is this doesn't work this way across the country, and we only need to look to our neighbors for evidence of that. New Hampshire, recovery residences are treated as group homes. In Maine, they have a broad exemption to landlord tenant law that we've shared with this committee previously that has led us to where we are today. So just looking at those two neighbors, it isn't just pure landlord tenant across the country. I think where some of that comes from, and the Oxford model has been referenced today, and Oxford and a lot of the for profit providers, you begin to see where, oh, okay, Jeff rents his home to a number of individuals in recovery, and or she should follow landlord tenant law. In Vermont, it's very different. All our operators are nonprofits, they provide the recovery supports that we're talking about. They're not business people, they're just simply renting out properties. So it's a it's a very different, landscape here. And then the final thing, that I will say, with regard to certification, I would like to implore you, that we keep certification voluntary. This is absolutely essential in being able to ensure the quality and integrity of this. If we mandate certification across the state, there are going to be providers that we're going to have to lean to accept, and they're probably going to be very difficult to work with because of their belief structures. And if they lose certifications, that mean we shut them down, they can't have this business. And probably equally important is individuals deserve the right to choice. And there are the only reason why a home potentially in Vermont is not certified is they don't have the proper space. We've run up against that recently for the number of beds that they're funded for. Two, they don't accept medically assisted treatment because their model is purely abstinence based. So they don't want any substances on the property and people agree to that. That's what they're entering. And they don't follow, they don't and they won't follow these exiting criteria that we've talked about. They do have that immediate discharge. And I think that's what has hurt us over the years is those programs that operate that way, we're kind of labeled in the same camp. Certified homes, as you know, don't immediately discharge people and ask them to leave without a place to go. So I think that it's been very intentional across the country that the NAR process be a voluntary standard. I do appreciate the concern that you folks have discussed with this. And if we don't just simply say certified or not certified, maybe there is another term for those homes that don't meet the certification criteria.

[Representative Theresa Wood (Chair)]: Thank you, Jeff. We've got a

[Representative Jubilee McGill]: couple of questions here, Representative Noyes.

[Representative Daniel Noyes (Clerk)]: Thank you so much for your testimony and all your work on this. So are you saying that a residence that is not certified through NAR should be able to have the exemption from landlord tenant laws.

[Jeff Moreau (Executive Director, Vermont Alliance for Recovery Residences)]: No, no. Okay. Wanna clarify that. Yeah, Representative Noyes, thank you. I think that as the bill before it sunsets states, this only applies to those homes that are certified and meet all these exiting policy requirements and so on. So a non certified home would not be able to have these protections. Further, I think there's such an investment going on at the state around funding that that's an enticement if it's appropriate to become certified. And again, I think as a state, don't want to speak for Emily, but my understanding is these programs need to be certified to be able to access the vouchers that we offer and so on. So there is that enticement to become certified if appropriate.

[Gregory Tatro (Co-Founder, Jenna's Promise)]: Thank you.

[Representative Theresa Wood (Chair)]: Jeff, I have a quick question and maybe my memory is not serving me correctly, but when you were referring to the stabilization beds, I recall the testimony from two years ago saying that residents, not E N C E S, were certified, that that was one of the requirements that they had in order, It's one of the certification requirements. And that they were that there were maybe not the existing ones that have been developed in the meantime, but there were places where people, if they were asked to leave that residences assisted people to go. Am I remembering that correctly?

[Jeff Moreau (Executive Director, Vermont Alliance for Recovery Residences)]: Yes, that is correct. And that has been what's been happening for the last two years. So each of the residences have to have a space for that individual to go to if their safety plan can't be implemented. I refer to those as respite, just to differentiate between the stabilization beds.

[Representative Theresa Wood (Chair)]: I

[Jeff Moreau (Executive Director, Vermont Alliance for Recovery Residences)]: think, you know, what's exciting is the stabilization beds really do serve as that ultimate safety net. With all this said, that has been the practice. I think going forward, arguably, there's a need to scale that further geographically around the state. And we'd really like to see that happen. And ideally, and I'll let David speak to this and Gregory as operators, but ideally, we'd like that to serve as that respite space as well, because what we're seeing in our utilization is we're keeping space open that could be utilized as a recovery bed in the event that we might need that. And there's a better use for it if we can move more to the stabilization model where we have trained people that can work with those individuals and provide better outcomes in terms of what their next steps are.

[Representative Theresa Wood (Chair)]: Okay, thank you. Go ahead, Representative McGill.

[Representative Jubilee McGill]: I was just, could you tell us about how many of the stabilization beds there are currently? Agree. I'm very happy that these are being worked on. I'm just kind of wondering what the number is and where they are located geographically.

[Jeff Moreau (Executive Director, Vermont Alliance for Recovery Residences)]: I will yield to the department.

[Representative Theresa Wood (Chair)]: Health department is, Emily is raising

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: her hand. Right now we provide funding. There's not an allocation of beds. In our role, call it reengagement stabilization. So there's some different names that are out there flying around. We provide funding to both Ceridian Health Insurance Program as well as Valley Vista so they can use their beds as individuals presented to their programs. We don't carve out, similar to a job of speaking to any beds used. So it's an allowable expense within their program.

[Representative Jubilee McGill]: Have you run into an experience where a Fed hasn't been available for stabilization or reengagement if needed?

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: I've checked. Okay. Okay, great.

[Representative Jubilee McGill]: And then I did just have one more question.

[Representative Theresa Wood (Chair)]: Yeah, okay.

[Representative Jubilee McGill]: Was just you had mentioned how you review every report when someone's released either temporarily or permanently. Would you be able to give us an idea about how many of each we see in our state each year? Either now or later, I understand you don't have all of these numbers memorized and at your fingertips.

[Jeff Moreau (Executive Director, Vermont Alliance for Recovery Residences)]: And Emily, you may want to reference the report that your department has put together for that purpose. We have provided a detailed summary for you on that, and we could we could get into greater detail with that, but we have submitted a report.

[Representative Theresa Wood (Chair)]: Yes. We we have that report on our it I I think it's actually I just looked at it.

[Representative Jubilee McGill]: Might have it open.

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: Have a There's a paper made in the PowerPoint.

[Representative Theresa Wood (Chair)]: Yeah. Oh, that's fine.

[Representative Jubilee McGill]: I have it open. I'll find it.

[Representative Theresa Wood (Chair)]: I saw it. That was sort of my question because I think I'm remembering the number 30 from that report of people who were exited And having two providers that have been funded to have resources open, I think it probably That's why I asked that follow-up question because it's not only those two beds, it's the other support that certified residences. So if somebody wasn't able to access support at one of those two providers, the certified residence is obligated to provide assistance to that person if their safety plan for some reason is not workable. Is that right?

[Jeff Moreau (Executive Director, Vermont Alliance for Recovery Residences)]: Just wanna That's make the intent going forward for sure. And that has been the history. So it's the individual's plan, if that can't be executed, it's the respite space that the home has made arrangements for. And then if that can't be executed, then it's these re engagement beds. And I apologize, I should know that terminology by now, we have gotten away from respite and stabilization, and Chad's program is called re engagement. And they have more than two beds, you know, they have several beds at Chad's program, several beds at Valley Vista. You know, it depends on their, it depends on how many people they have in the

[Representative Theresa Wood (Chair)]: In treatment.

[Chad Vige (CEO, Recovery House, Inc.)]: Yeah. I guess that's right.

[Jeff Moreau (Executive Director, Vermont Alliance for Recovery Residences)]: So they have that flexibility. It's they're not specific beds for reengagement.

[Representative Theresa Wood (Chair)]: Yeah. Yep. We we heard that on this because we need to move on to awareness.

[Representative Eric Maguire]: On this point, I just Okay.

[Representative Todd Nielsen]: Just wanted to verify if I understood correctly. You indicated you review the reports and in your time of reviewing the reports, has that been over the last two years that no one has been exited into homelessness? That is correct.

[Representative Eric Maguire]: Okay, thank you.

[Jeff Moreau (Executive Director, Vermont Alliance for Recovery Residences)]: And then the exiting that Chair Wood referenced, the 30 ish number was for this last year. And then we had done a six month report, I believe, prior to that for the previous year.

[Representative Theresa Wood (Chair)]: Okay, thank you very much. We appreciate it, Jeff. We're gonna move on to David Regal. Yes? Yes. If that's fine with David. David, are you alright if we move on to Gregory? He has a his son is here with him.

[David Riegel (Executive Director, Vermont Foundation of Recovery)]: Yes, happy to yield the time. Thank you.

[Representative Theresa Wood (Chair)]: Okay. Well, no, we'll get back to you. Okay, Gregory, lovely to have you here. Come on. Welcome to the red chair.

[Gregory Tatro (Co-Founder, Jenna's Promise)]: Hi, everybody. Good to see you.

[Chad Vige (CEO, Recovery House, Inc.)]: Good to

[Representative Theresa Wood (Chair)]: see you as well.

[Gregory Tatro (Co-Founder, Jenna's Promise)]: Really grateful to talk with you all, and thank you for your all continued work around our efforts to make recovery, as well as just your service to the state too. Of a geek when it comes to this stuff, but it's something that's deeply meaningful to watch. So my name is Gregory Quetro. I am a cofounder of Jenna's Promise. I spoke previously on Recovery Day to a few of you down during the joint committee that we did. For those of you who don't know, my sister Jenna lost her life after six years of struggle with substance use disorder. Jenna's Promise is named after her wish to help others, and I wanna stay grounded in that same story, but also focus more clearly on what we've been building and why S 157 matters to making it work the way that it's been intended. Across Vermont, there's a mosaic of recovery residences from you just saw Dave Regal and the Vermont Foundation of Recovery. We have Ben's House and Second Wind. Each one of those places serves as a lighthouse for people that are looking for safer and more structured shores. I'm here to explain why S-one Hundred 57 will benefit all of those recovery residences and why it deserves your support, but my hope is to also do this from the perspective of Jenna's story and the somewhat unique viewpoint of what we call ourselves, which is a recovery village that is Jenna's promise. You see, my sister's story wasn't a failure of effort. It was a failure of continuity. It was a failure of scaffolding. She encountered systems back in 2019 and before that worked in pieces, but not together, that didn't add continuous support. Moments of care, they weren't connected to what came next. And in recovery, fragmentation can be as dangerous as absence. That's what led us to build something different, not another program, but a connected pathway. So today, Genas promises what we call a recovery village. This is a holistic model of recovery that integrates four pillars. One is a program based recovery residence. We have a workforce development pillar, a health and wellness pillar, and a therapeutic clinical support pillar. Jenna's Promise just doesn't lift people inside our doors. We also focus on lifting the town around us too. We've helped empty buildings become workplaces and watched neighbors begin to let go of stigma and seen a community that was defined by continual loss begin to define be defined by new life and activity. At Jenna's Promise, the residents that we're talking about today is one building in our larger village and program, not the container of it. Each pillar carries its own expectations, and residents have to move through these four phases by meeting those expectations across the system. And I have the most incredible team that I work with who pours everything they have into this work, not because they make a lot of money, let's be realistic here, right, but because they believe. They believe in the mission and in the people who walk through our doors looking for another chance, and working closely with people like Dave and Jeff and Chad, they believe too. They're not here for anything but to try to help people. When you support places like Jenna's Promise, you're not only supporting residents, you're supporting the people who move mountains for them. And that's what brings us to s one fifty seven because it gives those people lawful footing to compassionate accountability. At Jenna's Promise, expectations live across the recovery village. Almost every resident rises to meet them and to see them change and grow and to leave with jobs and homes and reunited with their families is one of the most incredible things that I think that any person could witness. But in rare cases, after every effort has been made, our team is forced to act. A resident might completely disengage from the clinical pillar or undermine the workforce environment others are trying to learn from and is integrated into the town and the community. Those challenges can occur outside of the residential pillar, yet the only mechanism we have to protect the whole recovery village is a decision that touches the recovery residents piece of this. This fragments the values and the essence of our organization, And fragmenting care can be a huge barrier because it means that we treat some of the most difficult situations that a staff member has to go through, which is often emotionally laborious, difficult, heartbreaking at times, but is somehow separate and dissonant from the very supports and themes that make recovery possible in all other aspects of our program. So s one fifty seven helps to align the law with the lived reality. It allows an interdisciplinary team to act not in punishment, but in stewardship of the entire community because our process already moves with care. We already have, when people are struggling and they're not following the program, an accountability plan followed by restorative action, multiple team based meetings and improvement plans. We have weeks of probation, we check back in to make sure requirements are being made, and we'll even phase them back into the program with added supports to try to keep on bending over backward to give them a chance and repeated opportunities to reengage. It's only after every option, often over months, where oftentimes the residents actually feel like we waited too long and it was disruptive to the community. Only after that's been exhausted does x have become a last report. You resort. S one fifty seven gives us ability to be consistent, to be fair, to be responsible. And I urge you to go back to the residents who spoke at the joint committee on recovery day, lived this and saw this. They continually emphasized that when someone cannot engage with the program ports of the program itself, the impact is felt alongside everybody that is trying to rebuild their lives. Just a few days ago, I saw something as simple as someone saying how they could go get drugs easily. This is obviously not a dischargeable thing at all. But just this simple saying of that caused one of our other residents to cascade and start having dreams about returning to use, start wanting to return to use, and think about the program. We're dealing with people who are not people who are sitting in a bed and renting an apartment. These are some of the most fragile people who need some of the most support that they can offer in state. And so I would say most people, experts, those people in long term recovery, the residents of Genas Promise or any of our recovery residences, employees on the ground, will tell you that consistent and consistency and accountability is critical in early recovery. It's the banks of the river, the channel that keeps the water moving forward towards recovery. This still doesn't make any of us harsher, it makes us steadier instead of fragmented. And for people rebuilding their lives, that steadiness matters, because in recovery, even hope needs scaffold. I saw what happened with Jenna when she returned home after treatment, and talking to my parents who experienced it far more than I did. She had few options to continue her journey, and she had no scaffolding to hold up her early recovery. I know if she had access to the growing infrastructure of our partners across this state, and these organizations who have continued to grow and strive and experiment and reach people who you're gonna be talking to today, she would have had a better shot where she lagged today than in the teens. I hope that if something like Jenna's promise had existed for her, she might be here in this seat instead of me, but the scaffolding wasn't there, and so she isn't either. They say the greatest lessons of life are purchased with pain. I wouldn't be in this room asking for your support for s one fifty seven if I didn't believe it would genuinely make a difference in furthering the time, the pieces of ours and those of the recovered residences together into one world of more continuous care. And in the dangerous world of recovery, as we all know, A difference like that too often is whether someone is missing from your life or is there growing and changing and becoming who they were meant to be with that second chance that all who take that bold step into recovery deserve. That's true in a recovery village like ours. It's true for our incredible partners across the state doing this work, hard work, every single day. And with that, I just want to say thank you very much.

[Representative Theresa Wood (Chair)]: Thank you, Gregory. And could you make sure to send your comments along to Laurie afterwards so we can have them for the record? That would be great. Questions for Gregory? For those of us who have visited your program, we've seen the change that it's made in lots of people's lives, but also in the village of Johnson as well and the surrounding community. When you talked about the impact on individuals, that's very evident. But when I think about the impact and the changes it's had on the community of Johnson, I think that's just as poignant, really. It's really quite remarkable. And you and your family have done a lot to establish that. And the new leadership and the continuing evolution is great to see. And thank you for sharing your personal story, which I know is always a hard thing to do. As you said, it's why you're sitting there and your sister's not. And I appreciate the fact that you do that. Thanks so much, Gregory. Okay. Dave, you there? Okay.

[David Riegel (Executive Director, Vermont Foundation of Recovery)]: I am. Thank you. Welcome. Thank you, I appreciate it. I think this is my first time in a while having the privilege to be a part of this space and I couldn't be more grateful to see the number of people speak articulately and passionately about recovery residences in the state of Vermont. Was able to enter the inpatient treatment system back in 2007, back some of you remember Maple Leaf Farm. And a lot of the work that we've done at Vifor was born out of my own personal experience exiting an inpatient treatment facility in Vermont and not having a lot of options for next steps. And I'm blessed to have support from family and friends and and resources to be able to have a roof over my head and stand on on my my two feet as I was in my early recovery journey in a way that many people that I left treatment with did not. And that's a lot of what inspired our work to try to lift up this component of the system of care in Vermont over these years. So my gratitude goes out to everybody in the room and to the point that the committee made earlier around the leadership at the Department of Health and DSU over the last several years, really stepping up and into this space in a meaningful way. TAB, It gives us a lot of hope moving forward of what this work can look like over the coming years. So thank you chair wood and members of the committee for the record, my name is David Regal I'm the executive director of Vermont Foundation of Recovery. Our organization operates 10 certified recovery residences across Vermont providing a vital bridge for individuals transitioning from the isolation of active substance use to the connection of stable peer supported living. I'm here today to speak in strong support of S-one 157. This bill represents the maturation of our state's recovery infrastructure. We have moved beyond the pilot phase into a system that is data driven and built on national standards. Recovery housing acts as structured a structured recovery program, not as a traditional rental arrangement. They are pure based environments built on shared agreements, accountability and clear safety standards. Members enter voluntarily with a clear understanding of recovery based expectations that support both their own well-being and the well-being of others in the home. Most members enter recovery housing at a very vulnerable moment. Approximately 62% come to us from unstable housing. When someone enters one of our homes we do not simply provide them with a door code. We work them proactively to develop an individualized safety net plan identifying emergency contacts options before a crisis occurs. Homes are designed for stabilization with an average length of stay of six months helping people bridge the gap to long term stable housing. Section three of S-one 157 expands the grounds for an immediate exit or transfer to include theft, criminal charges, refusal to engage in services, and interference with others recovery. While debate often focuses on the individual leaving, I wanna take a moment to focus on the six to eight other residences who stay. The inclusion of these grounds is not about punishment. It's about community integrity and safety. Recovery is built on honesty. Theft in a shared home shatters the sense of safety and acts as a direct trigger for relapse for everyone else in the house. When a member pulls away and stops participating, it is often a sign of isolation that leads to relapse. In a peer driven culture, this behavior is contagious. It erodes trust and destabilizes the environment for those still trying to find their footing. Our staff, volunteers and residents deserve a home and work environment free from intimidation or the threat of violence. We need an immediate pathway to remove these threats without months long delay of a standard eviction. Crucially, this expansion also benefits the person being exited. Without the clear programmatic authority provided in S-one 157, operators are often forced to involve law enforcement to manage conflicts. We want to avoid calling the police whenever possible. Police interactions can be traumatic for the individual, the housemates, and the neighbors. Furthermore, criminal charges create a paper trail that make it significantly harder for that individual to find future housing or employment. By utilizing a programmatic exit, we handle the issue in house and allows us to move a resident to a higher level of care, such as the reengagement beds talked about at surrounding house or Valley Vista without the permanent stain of a criminal record. Example, in one example, a member entered a recovery residence after completing treatment and initially engaged fully. They worked, attended recovery meetings and contributed positively to the home. Over time, their engagement changed. They stopped participating in required programming, repeatedly violated house agreements and began taking belongings from other members. Eventually, their behavior escalated to intimidation that made others feel unsafe. This was not about returning to use. Recovery residences understand relapse as part of substance use disorder and respond with support whenever possible. This situation became about ongoing behavior that interfered with the recovery and safety of others. In a shared recovery environment, disengagement does not happen in isolation. When one member repeatedly refuses to participate in programming or shared responsibilities, it erodes trust, it weakens accountability, destabilizes the culture of the home. Members in early recovery rely on consistency and predictability. When those elements break down, it increases fear and relapse risk for others who are still stabilizing. The language in S-one 157 recognizes that timely intervention in these situations is protective, not punitive. It allows recovery residences to act when an individual's behavior poses a risk to the health and safety of others in the home. When exits occur, certified residences do not simply put people on the street. Vifor works with community partners to utilize reengagement beds, stabilization beds, and other temporary housing options as appropriate. Recovery residences rely on shared membership agreements, not lease. Members enter with written consent to recovery based expectations and safety standards. When a member repeatedly refuses to engage in programming, is charged with a crime, engages in theft, interferes with the recovery of others, or threatens health or safety, interventions become necessary to protect the rest of the community. I do have one proposed amendment to S-one 157. To ensure these programs function safely, I strongly urge the committee to add nine VSA section 4,460 regarding notice of entry to the list of exemptions in section three of the bill. Our house coordinators do not just visit these homes, they work there. These residences are program sites where house coordinators have office space. They must be able to enter the home to conduct administrative work and maintain the facility even when members are out. Furthermore, house coordinators are the primary point of contact for new members arriving from treatment. Transportation for these individuals can be fluid leading to rescheduling at the last minute. Because we aim to welcome new members and provide orientation in the privacy of the home, a forty eight hour notice requirement is a logistical impossibility. To properly serve someone the moment they are ready to transition, house coordinators must have the flexibility to be present in the home to greet them and begin the orientation process immediately. Already heard. Already dropped. Yeah, I'm sorry. Paused too long on you, Chairwoman.

[Representative Theresa Wood (Chair)]: That's all right.

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: It's all good.

[David Riegel (Executive Director, Vermont Foundation of Recovery)]: I want to remind the committee of the joint hearing that Gary mentioned earlier for the same reasons. We heard lots of folks from our homes and many others express their desire for accountability and safety. They asked for a system that prioritizes the recovery environment. S 157 is the answer to that. Recovery residences are a vital part of the continuum of care, but they are not appropriate for everyone at every moment. S-one 157 helps ensure these homes can continue to serve the people they are designed for while maintaining recovery integrity. This bill provides the policy alignment and legal clarity that recovery residents operators and house coordinators need to continue this life saving work. It protects the collective, supports the individual in crisis, and honors the progress Vermont has made. I urge the committee to support this bill and to include the exemption for section 4,460. Thank everyone for their time and your dedication to the health of all Vermonters.

[Representative Theresa Wood (Chair)]: Thank you, David. Question for David. I have one. I don't have the bill right up in front of me right this moment. It's the addition of the interference with others' recovery section. I'll be honest, that seems pretty broad to me and feels too broad. Because for me, that feels like that's already covered in the sort of basic elements of the ability to have somebody exit when we're talking about the safety of others. So I'm just wondering your thoughts about that specific language and why that specific language is necessary and you don't feel that it's covered in the broader human language.

[David Riegel (Executive Director, Vermont Foundation of Recovery)]: Well, I think I would go back to the framework that Gregory laid out in his testimony when he talked about giving people multiple opportunities. So none of these are about one instance of behavior. So what could be impacting somebody's recovery may look very different from individual to individual. And it's about engaging in the process of somebody being able to stand up and set their own boundaries, advocate for how somebody else's behavior is impacting them, and go through the dialogue and the request for their behavior to change. And when you're living in a group environment like these recovery residences are, that willingness to work together to make sure that the culture of the home and the environment supports a recovery atmosphere is really critical. And so I don't know that we want to limit it to exclusive behavior because it could look very differently. The the purpose of this is to ensure that folks are gonna engage in that process with the other members of the home and the staff to be able to resolve situations as they arise. And in the event that they're not willing to change their behavior to meet the community expectations or they're not willing to engage in the process, we need a way to be able to move people to a level of care that's more appropriate for them.

[Representative Eric Maguire]: Yeah, that's something, what you use with this? I mean, that's a fundamental practice, the behavioral contracts, because that's actually also trauma informed practices that get mixed. When you're living in congregate communities and individuals are exhibiting behaviors and attitudes that become vicarious trauma placed upon the staff and as well as other residents that trigger other participants as well as staff into their own trauma because they're exhibiting this, and then the practices to work with them in a more behavioral type contract. And then when those are not going, are ethically on the right if you need to discharge. It's unfortunate that these things occur, but it's vitally, vitally important to also keep mechanisms in place that are supportive to participants without feeding into that vicarious trauma that is being exhibited through behaviors of participants. It's the old, we can't sacrifice the money for the one. I get where you're going that it is a very broad statement. I believe there is a more narrow tailored statement that we can put in that covers where everything is kind of going within this conversation?

[Representative Theresa Wood (Chair)]: Yeah, I mean, I think that the part that I'm just trying to understand better is a person, because that statement is so broad and just exactly as both of you have just said, it could be any variety of things that might trigger somebody else's issue with recovery. And the person who is doing the behavior might not know what that is. But what I hear you just so that they would be doing something that they didn't realize was having an impact on somebody else's recovery. But what I hear you both saying is that that's then really part of a process for the individual being impacted to stand up for themselves and to work with that individual with the assistance of staff to identify a way to overcome that triggering, those triggering behaviors.

[Representative Eric Maguire]: Works of behavior that's being exhibited. We need to work on this behavior. If that behavior continues to be exhibited and so forth, then this is the next step to the point to where enough is documented to where you are ethically, you know, sound in the decision. It doesn't mean like, oh, I witnessed him say this to this participant. Therefore, they got to go. No, no, no, no, no. That's what anybody said.

[Representative Theresa Wood (Chair)]: Yeah. I I think we can work on the language a little bit. It's a it's a little too amorphous for my comfort level, to be honest. But any other questions for David?

[Representative Eric Maguire]: I I do have a couple.

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: I have record.

[Representative Eric Maguire]: Dave, great seeing you. We're gonna connect soon. How are your parents doing just quickly?

[David Riegel (Executive Director, Vermont Foundation of Recovery)]: It it ebbs and flows by the day.

[Representative Eric Maguire]: Alright. That wasn't my question, though, but it's good to good to see you. Do you believe and I think I I I heard Jeff also mention the same thing, but I just wanna get it confirmed. Do you believe there should be a prerequisite of certification to be able to have the exemption of the tenant landlord.

[David Riegel (Executive Director, Vermont Foundation of Recovery)]: Yes, absolutely. Okay. I we started this whole thing, you know, with bringing VTAR to the state of Vermont because we believe strongly in a voluntary certification process to lift up best practices and national standards and create a baseline level of care. I've always believed in the carrot, you know, model when it comes to this both in terms of funding the voucher support, the zoning bill that you all worked so hard to get through a couple of years ago is based on certified recovery residences and I certainly believe that any exemption to landlord tenant law should only apply to certified recovery residences.

[Representative Eric Maguire]: Okay, thank you.

[Representative Theresa Wood (Chair)]: Hey, thank you very much, David. Appreciate it. And David and I go way back since when he was like really little. I won't tell any stories.

[Emily Trudder (Division Director, VDH Division of Substance Use Programs)]: Okay,

[Representative Theresa Wood (Chair)]: Chad, welcome. Thank you for being so patient this morning. Glad to have you.

[Representative Todd Nielsen]: Chad, if I could just offer while the thought was in my head, I wonder if that interferes, would recovery materially interferes? So is it slightly higher, less subjective?

[Representative Theresa Wood (Chair)]: Discipline. I I think that that those are things we can talk about during a markup and further discussion. I just wanted to raise it because it it was just something that I have to say just stuck out to me. The other items are things that are sort of like, I think, a common understanding of what it would constitute. And that last one is like, well, I can see that being more vague, more interpretive and that being we just have to think carefully about it, that's all. Todd, thank you. Welcome to the hot seat.

[Chad Vige (CEO, Recovery House, Inc.)]: Thank you, Madam Chair, thank you, committee members for having me. One suggestion before I jump in would be the term milieu disruption. So that's a term that we use on the treatment side of things, the catchment, right? We have to define what disruption looks like, but to capture all of the possible behaviors would require a 40,000 page document. Exactly, right. So thank you again for having me. My name is Chad Vige. I am the CEO of Recovery House Inc. I also moonlight in the social work department of Vermont State University at Kassington. I have effectively been managing milieus for the better part of fifteen years in the treatment capacity. However, milieus in residential are milieus in residential. Getting individuals to cohabitate together is no easy task. I appreciate the efforts of partners who have already testified today. And I want to speak about, A, who we are and how we interact and how we're interconnected with the operators of recovery residences. And I want to shed some light on our position for S157. So Recovery House, as beautifully laid out by Emily, is an umbrella organization that holds Serenity House, Grace House and McGill House, all three being substance use residential treatment. So we don't actually operate a recovery residence. So I'd like to think I don't have a business interest in this bill, but what I do have is a very passionate interest in the clients that I serve. And I have interest in providing care with an opportunity at the end of the care that I provide. And these recovery residences provide a wonderful opportunity to engage in the system. NIDA, the National Institute of Drug Abuse, has put out best practices for treatments and one of those best practices is to remain in treatment. Now that does not mean remaining in residential treatment, it means remaining in the treatment continuum of care. And the best way that I have seen over my years in having individuals remain in the treatment of care is to be in healthy, safe living environments. And that's what these recovery residences do, and that is their goal. The interconnectivity that we have with recovery residences speaks to that. We rely so much on the recovery residence system. When we send folks back into unsafe environments, whether through their choosing or lack of opportunity in the system, we fear the worst as treatment providers. Unfortunately, we cannot keep individuals forever in our programs, and sometimes it is an impossible task to find a place for them to go that is safe. And so any piece of legislation that is designed to maintain a safe and healthy and structured environment, I am in support of wholly. I am in support of s one fifty seven as written, including the proposed amendments that David presented, their operators do need to be able to enter the facility at any given moment to maintain that it's safe and recovery oriented. And speaking of that, when we talk about milieu management, we have many rules in our treatment facilities, but you can boil it down to two themes. They must be safe and they must be recovery oriented, and when they are not, when an individual or individuals pose risk to safety or the recovery orientation of the environment, many people are at risk. In the treatment world, we have the freedoms of administratively discharging, However, it does require some due diligence on our part to make sure we try to connect them to the next step. And I hear that from our recovery residence partners as well. But having the ability and being held with the responsibility of keeping individuals safe, providing an exit, a structured exit plan is an important part of the process. Now we play a role, even though we're treatment providers, in their exit strategies in the recovery residence world. Prior to the establishment of engagement beds, David and I decided to try something wild. We had these public inebriate beds at our Grace House, and we said, you know what? What do we do with the folks that leave your facility in Rutland that have no place to go that have to be exited because they're posing a risk to others and ultimately themselves. Well, let's get them back into treatment. Well, what if treatment isn't available in that moment? Maybe they have to wait a day. Let's get them into one of these beds. And we tried that for a few years, and ultimately what was born of that is the engagement bed system. So this has been something that we're very familiar with. We've been using it in practice, and actually, I come with a really good story from this. Early on, we had an individual who walked through our highest level of care at Serenity House and did remarkably well. You know, this was someone that we said, hey, you would do great at Vermont Foundation of Recovery. David's team, you know, accepted, and we transitioned them to the Rutland location. They spent some time at the Rutland location and then they started to destabilize. They were not engaging in the program. I believe there might have been a return to use, but in any event there was some sort of rule breaking or social norms or milieu disruption that was occurring. And so David's team reached out and said, hey, we have to remove this guy from our house or other people will be put in danger. And so we accept that person into an engagement bed. We immediately called our Serenity House screeners the next morning, because this was in the evening. We screened the person, we got them back into treatment, residential treatment, and then we understood, hey, we've got to try something different with this person, they weren't quite ready. And so we brought them to Race House, our 3.1 treatment program, where they receive residential treatment for three months, and we said, wow, they are in much better condition here. We really think they're ready for Vifor now. And they transitioned back to Vifor. And they stayed, to my knowledge, for a year, found their own place, found employment, and they did well up until the last point that I was aware of their situation. So it kind of speaks to this idea that removing someone isn't necessarily a bad thing. In fact, I would argue that removing someone when necessary is positive for the individuals remaining in the home and the individual themselves. Because if we don't address, from a clinical perspective, if we don't address behaviors that are maladaptive and addictive in nature, that person will repeat those behaviors. And if they're going to repeat those behaviors in a setting that puts other people at risk, that's incredibly dangerous.

[Representative Theresa Wood (Chair)]: I think Chad, it's helpful to hear sort of like real life examples like that. I think that some of the opposition about this in the past, I think has also been based upon what wasn't available in the past. And I think that we have had concentrated development of the system, particularly in the last four years or so. And so it's helpful to see that those kinds of situations actually can, like you just said, be beneficial for the person who is being asked to leave and the people who remain, and then can ultimately lead to better outcomes for both of them. But there is still, I think, some sort of pent up concern about enacting this on a permanent basis, which is why we didn't make it permanent the first time. But appreciate hearing the use of these resources in creative ways. And part of it, think, is back to what Emily said from BBH is making sure that we have resources available in all parts of the state. And that's really important to us here in terms of statewide access for equity and access to these services. So if people want to leave their home county or whatever, that's perfectly fine, but lots of people don't sell either. But it's helpful for you to describe sort of how the system can work and how we would hope that it would work in all circumstances. But we know that there are places where it doesn't always work that way.

[Chad Vige (CEO, Recovery House, Inc.)]: It doesn't always work that way, and I think we'll see some challenges being as rural as we are. But one other story I do have, and since Gregory was here testifying, there was one time, Don Tetrault had called me at 10:00 at night, said, hey, I've got somebody, and we're in dire straits here. We brought them down middle of the night, one a. M, into our engagement bed. They had transportation, which I know can be a challenge, but wherever you are in the state, if we can make that happen, we want to be that safety net. We have been, and I think it's worked out very well in the cases that we've been involved in.

[Representative Theresa Wood (Chair)]: Well, and thank you for sort of illuminating on the linkages between the recovery housing and your treatment and engagement beds and even the public inebriate beds. And how I was thinking in my head when you were talking about the sort of umbrella organization, was thinking like, oh, you didn't mention the public inebriate beds, but then Any questions for Chad? Yes, go ahead.

[Representative Eric Maguire]: I just want to add something to what everybody said. This is also a testimony of providers doing everything they can to be better, to work better, to hang in there with people, not give up on them, continue to fight, continue to move through even when those resources are not available. But we continue to keep plugging away, plugging away, and knowing the value of the individual that we're working with. And I appreciate all the work that's been put in by all of these organizations that are out there every day doing the best they can to help an individual in need and engage the services. And knowing that these measurements get put in a place for everybody's benefit. That's why they're so important. To also hear, yeah, we weren't in that position last or a couple of years ago to where this is all, it was practical, but it wasn't applicable. Now we're in a position to where it's not practical, and it can be applied. And I believe if we get a few of these things cleaned on up, and a couple more mechanisms in here, we're going to have, without a doubt, one of the best statutes in place supporting the wonderful work everybody's doing.

[Representative Theresa Wood (Chair)]: I think that's really important because I it's kind of what I was getting to when we had Emily up here. The providers out there have actually moved ahead of the state. And it took us here in this building and in state government a bit of time to catch up to that and really devote the resources and really integrate the importance of recovery along with treatment and prevention and harm reduction into the full system. And from the ten years I've been on this committee, I've seen a tremendous growth in what's been available to people where the beginning, honestly, this committee, we were only talking about hub and spoke. That was it. You remember, Dan? Yeah. And it really has evolved since then. It really has. So thank you for your part in that and for all of the witnesses this morning. And I echo what Representative Maguire just said. So thanks again. We'll be meeting with a few other witnesses, and then we'll start markup. I look forward to having a positive outcome for this go. Thanks, Chad. Appreciate it. Thanks, Chad. Alrighty, Lori.