Substance Use Disorder Treatment During a Pandemic: A Conversation with TROSA

Today’s post is a conversation between Jamie Markham (JM) and Kristen Rosselli (KR), Chief Operating Officer at TROSA. We’ve been getting a lot of questions about how TROSA and other substance use disorder treatment programs are operating during the pandemic, so I thought I would go straight to the source to learn more. This post should not be viewed as an endorsement of TROSA in particular—it just happens to be one of the largest programs in the state, and the one about which I get the most inquiries. As always, my goal is to share up-to-date information so you can make informed decisions for the defendants, clients, and cases that come before you.

JM. Many of our readers have heard of TROSA, but for those who haven’t, can you give an overview of the program?

KR. TROSA was founded in 1994 by Kevin McDonald. We are a state-licensed, multi-year nonprofit residential program for adult men and women with substance use disorders. Our program is cost-free and residents do not need insurance. We serve a daily average of 400 residents at our Durham campus and provide free comprehensive services, which include: housing, meals, and all essential daily care items; full health services; counseling and daily therapeutic activities; experiential vocational and life skills training; education classes and professional development opportunities. Services are provided by licensed and certified treatment professionals, program graduates, peer leaders, and trained peer support specialists.

Kristen Rosselli, TROSA Chief Operating Officer

TROSA employs evidence-based therapeutic activities and practices in its structured two-year program. As part of their daily therapeutic program, residents participate in community assignments that provide vocational and life skills training. Community assignment placement can be public-facing in our social enterprises (TROSA Moving, TROSA Lawn Care, and TROSA Thrift Store) or in campus departments such as Admissions, Accounting, Medical, Food Services, Automotive/Truck Repair Shops, Transportation, In-kind Donations, Men’s and Women’s Programs, Warehousing, and Office Administration. At 21 months in TROSA’s program, residents can apply to stay longer or can prepare for program completion by securing local employment.  TROSA helps residents find employment and provides transportation to/from jobs. TROSA also has a department that provides continuing care services for graduates, which include affordable housing, transportation, meals, and support groups. The goal is that graduates leave our program with full-time employment, stable housing, reliable transportation, a support network, and the tools to continue practicing healthy behaviors. More information can be found at www.trosainc.org.

JM. How has COVID-19 impacted TROSA?

KR. TROSA has worked hard to ensure our doors can safely remain open during the COVID-19 pandemic. We’ve been fortunate to have access to excellent guidance from our health partners. As the pandemic hit the United States in March 2020, we made the decision to temporarily pause new admissions as we gathered expert recommendations from our local, county, and state health officials. In June 2020 we were able to safely re-open our doors to new admissions and continue to accept new residents today with no wait list. We have a COVID-19 task force that can quickly adopt and adapt best practices for our campus. Our practices today include vaccination and boosters for our residents and staff; weekly surveillance testing; mask wearing; social distancing policies; coordinated care plans and quarantine services for those residents and their close contacts presenting with symptoms or positive test results; and technology for remote education classes and telehealth when appropriate. TROSA’s COVID task force remains vigilant in the face of the new variants and we are all proud of our residents and staff for doing their part to keep the campus and our local community members safe.

JM. Is there a wait list for a bed?

KR. There is no wait list for admission. The primary requirements for admission to the TROSA program are that the individual must have a substance use disorder and desire a two-year residential treatment program. Individuals seeking admission must call or write to us directly and participate in an interview. We have a toll-free number 1-833-408-7672. Incarcerated individuals can write to TROSA and request an interview. More information about admissions can found at www.trosainc.org/admissions

JM. Our readers may be most interested in how TROSA works for residents who are attending the program as part of their involvement in the criminal justice system. Legally, I can tell everyone that a judge can order TROSA as part of a defendant’s probation as a “residential program” within the meaning of G.S. 15A-1343(a1)(4) or (b1)(2). You also have residents who are participating in the program as a condition of a deferred prosecution agreement. Can you tell us more about life at TROSA for your justice-involved residents? For example, for those residents who are on probation, what arrangements do you make for them to meet with their probation officer?

KR. Prior to entering TROSA’s program, 65% of our residents had a felony record and 87% were formerly incarcerated at some point in their lives. Last year 38% of our 756 residents served were on probation while participating in TROSA’s program and 7% were on parole. Our justice-involved residents fully participate in all daily activities; receive our cost-free services; and have opportunities to take on leadership roles, demonstrate growth, and learn and practice new behaviors and skills for future employment. We also work with local partners to offer expunction services and specialized veteran services. Last year, data showed that 98% of TROSA program graduates did not have a new criminal conviction one year after graduation. For residents on probation, we prioritize meetings with their probation officers, working across departments to ensure that probation officer meetings do not conflict with other important appointments a resident may have at TROSA. Last year, due to COVID protocols, we were conducting probation officer meetings via telephone, but we are currently coordinating appointments in-person and on campus following COVID-safe protocols. Residents who are on probation sign a consent form, which allows us to communicate with the officers about a resident’s status. If anyone reading this has further questions about individuals on probation, they can contact our Admissions Manager Angela Warren at 919-419-1059.

JM. Are there any categories of defendants that are ineligible for TROSA? 

KR. TROSA cannot accommodate individuals with arson or sex offenses. We also do not allow ankle monitors.

TROSA is not a medical facility and there are some medications and chronic medical conditions that may be beyond the scope of our care. We conduct a thorough interview with applicants to ensure that we can accommodate their needs. Our on-site clinical counseling staff and Nurse Practitioner can assess if we are the best program for each applicant’s needs. We may request medical and/or mental health documentation to make a full decision. If TROSA cannot accommodate an individual, we can provide resources and references for other programs that may be more appropriate.

JM. TROSA has plans to create a new campus in Winston-Salem—something the General Assembly is supporting in the most recent state budget (S.L. 2021-180, sec. 9B.9.(e)(2)). What can we expect at TROSA Triad, and when will you be accepting residents there?

KR. For the past several years, we have been working with community partners to lay the foundation for the same services in Winston-Salem that we have in Durham. We have been planning a phased approach to our construction, and the state’s funding makes it possible for TROSA to realize our plans quicker and more efficiently. We secured a long-term lease on a facility owned by Forsyth County for the campus, which will be called “TROSA Triad.” We look forward to welcoming our first residents to TROSA Triad this year once our first phase of construction is complete. We will then begin the second phase of this effort that will expand capacity to a maximum of 200 beds. More information can be found at www.trosainc.org/trosa-triad.

JM. Any final thoughts about what people who work in North Carolina’s court and criminal justice systems should know about TROSA?

KR. TROSA is an evidence-based program for individuals who are seeking a better life. Our program reinforces the values of being honest with yourself and others, having the courage to do what’s right, a commitment to positive change, and being a responsible community member. Many of our residents have experienced addiction to multiple substances. Most have suffered traumas. Many of our residents have tried other treatment options before, and are looking for a new way forward. There are few programs that compare to TROSA in terms of length of stay, services provided, and post-program support for graduates. Last year 96% of graduates seeking employment received a job offer before their graduation date. One year after graduation, more than 90% of TROSA graduates are still in recovery, still employed, and have no new criminal convictions. To learn more about TROSA, you can call 919-419-1059 or visit www.trosainc.org.

TROSA residents participating in their community assignment in TROSA’s Admissions office

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