Strategy
Fund Warm Hand-Off Programs and Recovery Services
Warm hand-off and recovery support programs facilitate patient care and timely connections to recovery services.
Read Examples of OAA Funded Proposals
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Resources, Training & Guidelines
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Warm hand-off and recovery support programs are crucial to addressing opioid addiction. A warm hand-off is when a patient is directly transferred or introduced from one care provider or service to another, such as from the emergency department to a residential treatment facility. This ensures that individuals identified with opioid addiction are promptly connected to appropriate treatment services and helps facilitate collaboration and communication between healthcare providers.
Once connected, recovery support programs help individuals stay engaged in the recovery process by helping them to navigate the healthcare system and providing education about holistic recovery supports such as housing, case management, childcare, employment assistance, support groups, peer counselors, and recovery coaches, and provide ongoing follow-up care to promote long-term recovery.
Evidence-Based Strategies
Standardize the Warm Hand-off Process
Build strong collaborative relationships between hospitals, emergency departments, first responders, community service boards, and treatment providers to ensure a seamless transition from the point of contact to the appropriate level of care. Create a clear, consistent protocol for the warm hand-off, outlining the steps involved, the information to be shared, and the roles and responsibilities of all parties.
- Create standard operating procedures (SOP) outlining roles and responsibilities.
- Establish shared protocols and referral pathways.
- Provide training to all staff involved in the hand-off process. This includes training on OUD, motivational interviewing techniques, communication skills, and the specific protocols for referral and follow-up.
The Commonwealth’s Examples
- Piedmont Community Services Lighthouse program in Henry County is to expand capacity of support to those experiencing an emergency psychiatric crisis. The program has expanded their services to include 12 adult beds for crisis stabilization. This service will serve both Henry and Pittsylvania County residents.
- OAA Funded
- Rural
- Cooperative Partnership
- OAA Funded 2026
- Henrico County, Martinsville County, and Henry County: these localities are independently focusing on the familial impact of substance use disorder. Each locality will have a designated individual to help assist families in navigating resources and assistance for kinship caregivers in their role of providing children with support.
- OAA Funded
- Rural
- Youth
- Individual Distribution
- OAA Funded 2026
- Gloucester County is partnering with the local nonprofit, Bay Aging, to provide scheduled transportation services to MOUD or MAT appointments for local residents. Patients are able to “ride share” to their appointments to increase access to care.
- OAA Funded
- Rural
- Gold Standard
- Individual Distribution
- Culpeper County established a Recovery Court and partnered with the Bureau of Justice Assistance (BJA) Adult Drug Court and Veterans Treatment Court Discretionary Program. Recovery courts assist in bridging the gap between initial crisis and sustained community based substance use disorder services.
- OAA Funded
- Gold Standard
- Expansion of Resources
- OAA Funded 2026
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Wise County’s Recovery to Work Business Redevelopment Initiative is a partnership with the county and Recovery Soldiers Ministries to establish a “Recovery-To-Work” model for women experiencing substance use disorder. The recovery program partners with a Workforce training hub.
- Women
- Gold Standard
- Individual Distribution
- OAA Funded 2027
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The Southwest Virginia Workforce Development Board’s Reengagement Opportunities & Pathways to Employment Success (ROPES) program is a workforce development project intended for individuals ages 16 to 24 with a history of substance use to enter the workforce in Buchanan, Dickenson, Lee, Russell, Scott, Tazewell, and Wise counties, as well as the City of Norton. Participants will gain workforce development training, paid work experience, and career planning.
- Rural
- Youth
- Cooperative Partnership
- OAA Funded 2027
Provide Comprehensive Support Services
Addressing social determinants of health can improve treatment outcomes and reduce the risk of relapse. Offer a range of support services in conjunction with treatment to address the multifaceted needs of individuals with OUD. This can include transportation assistance, housing support, childcare, mental health services, and medications for OUD (MOUD).
- Conduct a needs assessment to identify the most pressing needs within the community.
- Partner with community organizations to provide linkages to comprehensive services.
- Use a case management approach to coordinate care and support.
The Commonwealth’s Examples
- Albemarle, Nelson, Louisa, Greene, Fluvanna and Charlottesville use VOAA funds to expand their Region 10 crisis intervention team assessment center (CITAC). The center serves as a location for individuals who can be diverted from inpatient hospitalization in under 23 hours.
- OAA Funded
- Chesapeake Regional Medical Center expanded psychiatric services by purchasing 20 beds for patients who need medically assisted treatment, detox, and co-occurring mental illness diagnoses.
- OAA Funded
- New Program
- The CSB serving Louisa County extended their services by hiring a full-time Counseling Clinician to assist with providing education, prevention and treatment to over 100+ individuals in the county. This application follows the VOAA “Gold Standard”.
- OAA Funded
- Hope House serves as a residential transitional living facility for individuals seeking sober living after incarceration or detox, serving the Buena Vista, Lexington, and Rockbridge areas.
- OAA Funded
- The Mobile Integrated Healthcare establishes an outreach team to provide comprehensive wrap-around programing to decrease the use of 911 for non-emergency reasons. MIH individuals respond to non-emergency events, to provide transportation support, peer recovery support, harm reduction materials, and recovery housing services.
- OAA Funded
- Expansion of Services
- Fairfax County, Alexandria, Arlington, Loudoun, and Prince William collaborated to create adolescent residential treatment facilities in partnership with the local CSBs to provide 20 beds for medical withdrawal management and offer longer-term residential care if needed.
- OAA Funded
- New Program
- Youth
- The regional mental health crisis assessment center (CITAC) is expanding its services in Rockbridge and Harrisonburg by increasing law enforcement coverage and enhancing 24/7 crisis assessment operations. The expanded services will also include medication-assisted treatment, harm reduction initiatives, and the distribution of substance use resources.
- OAA Funded
- Expansion of Services
- Louisa County expanded the role of their counseling clinician for the Region 10 CSB. The foundation of the role includes assisting with providing education, prevention resources, and treatment to the residents participating in the SUD program. The additional funds allows for
- OAA Funded
- Gold Standard
- Individual Distribution
- Colonial Heights is partnering with City of Refuge, a faith-based drug recovery center to provide transportation to patients. Transportation locations include detoxification centers, medicated assisted treatment facilities, peer recovery meetings, and other treatment specific needs. Municipalities participating in this program include the City of Colonial Heights, City of Hopewell, and Henrico County.
- OAA Funded
- Expansion of Services
- Cooperative Partnership
- OAA Funded 2026
- The Chesterfield Recovery Academy is expanding services to include transportation for students. The school encompasses 15 divisions including: Charles City, Chesterfield Dinwiddie, Goochland, Hanover, New Kent, Powhatan, Petersburg, Richmond City, Prince George, and Surry.
- OAA Funded
- Youth
- Individual Distribution
- Cooperative Partnership
- OAA Funded 2026
- Chesterfield County is hiring a Department of Social Servivces case support staff member, funded in 2026, to strengthen assistance for relatives caring for children affected by substance use disorder. A designated staff member will guide caregivers through available services and help them access financial and community resources. The program aims to reduce stress on families who often assume caregiving roles unexpectedly. It also focuses on promoting stability for children by ensuring caregivers feel informed and supported. This effort reflects the county’s broader commitment to reinforcing family networks and long-term well-being.
- OAA Funded
- Youth
- Individual Distribution
- Cooperative Partnership
- OAA Funded 2026
- The Intense Adolescent Outpatient Treatment Center in Wise county is currently substance use case management, group, peer counseling , independent therapy services, and education support. In addition, the program signed 3 MOUS with the 30th Juvenile Judicial Court and 3 different school districts.
- OAA Funded
- Youth
- Rural
- Individual Distribution
- Cooperative Partnership
- Roanoke CIty and Roanoke County are hiring two Navigator Care Specialists (NCS). These individuals will provide support services and assist with client needs regarding Child Protective Services or Foster Care. Duties include case management, case coordination with government agencies, and providing prevention materials.
- OAA Funded
- Youth
- Rural
- OAA Funded 2026
- Danville City and Pittsylvania County developed a program titled Recovery 360. This program is designed to assist participants with food, housing, and promote prevention methods for those participating in Treatment Court. The wraparound services are to eliminate financial barriers for the participants and incentivize treatment progress for graduation.
- OAA Funded
- Expansion of Services
- Cooperative Partnership
- OAA Funded 2026
- Unite Us Platform is a network for communities to send referrals for residents for services in their communities. If you are unfamiliar with this platform, ask your local health department on the available services and how to receive training.
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The Cabell Street Women’s Recovery Center is a licensed residential treatment program for eight women facing risks like justice involvement, low income, housing instability, and caregiving duties. Funded by Lynchburg City and Amherst and Campbell counties, the program removes recovery barriers by providing counseling, peer support, case management, and on-site medical care.
- Rural
- Women
- Cooperative Partnership
- OAA Funded 2027
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The West Piedmont Health District, Piedmont CSB, Virginia Harm Reduction Coalition and municipalities are providing comprehensive harm reduction by including STI testing in their outreach. Together, they will provide rapid linkage to care, whether that involves assistance with treatment, mental health services, public health resources, or community outreach. This program will serve Franklin, Henry, and Patrick counties.
- Expansion of Services
- Rural
- State Agency
- Cooperative Partnership
- OAA Funded 2027
-
Franklin County Family Drug Treatment Court uses funding to provide families with comprehensive support from DSS, treatment providers, local attorneys, school representatives, and mental health services. The wrap around care is to assist with kinship care and familial relationships.
- Youth
- Individual Distribution
- Gold Standard
- OAA Funded 2027
-
The Veterans Treatment Docket in Henrico County serves individuals with co-occurring mental health disorders. Federal and state requirements include multiple substance tests for pre- screening participants and current participants. The funding will go to maintaining the health services for Veteran Docket participants and compensating treatment providers.
- Individual Distribution
- Gold Standard
- OAA Funded 2027
-
Chesterfield County and the cities of Colonial Heights and Richmond are collaborating to provide a multi-year housing subsidy project. Each municipality will provide emergency rental and eviction support, housing navigators to assist participants with housing resources, and recovery resources.
- Individual Distribution
- Cooperative Partnership
- OAA Funded 2027
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The Valley Community Service Board (VCSB) Crisis Receiving, Stabilization, and Detoxification Center will feature a 16-chair crisis receiving area and a 16-bed crisis stabilization and detoxification facility. Established in partnership with the Department of Behavioral Health and Developmental Services, the center will serve Augusta and Highland counties, as well as the cities of Staunton and Waynesboro. This project will address the critical need for regional intervention and stabilization services, supporting individuals who are experiencing mental health crises, substance use challenges, or co-occurring conditions.
- Rural
- Cooperative Partnership
- OAA Funded 2027
Utilize Peer Recovery Specialists (PRS)
Incorporate peer recovery specialists (individuals with lived experience of OUD) into the warm hand-off process to increase engagement and retention in treatment. By providing a relatable and empathetic connection, they can provide support, encouragement, and guidance to individuals entering treatment.
- Recruit and train peer recovery specialists from diverse backgrounds.
- Clearly define the roles and responsibilities of peer specialists.
- Integrate peer support into all phases of warm hand-off programs.
The Commonwealth’s Examples
- Peer recovery-based supportive Warm Line through Blue Ridge Behavioral Healthcare serves individuals seeking assistance from substance use disorder through phone calls and chat services in Roanoke City.
- OAA Funded
- Rural
- Roanoke City uses OAA funds to hire a peer recovery specialist in their adult detention center to provide support to both staff and incarcerated individuals.
- OAA Funded
- Rural
- Rappahannock Rapidan Community Services (RRPCS) partners with law enforcement agencies across the localities of Culpeper, Madison, Fauquier, and Orange to provide access to a Certified Peer Recovery Specialist. This specialist assists individuals in obtaining immediate peer recovery services and community resources during their initial interactions with law enforcement, EMS, first responders, and other medical personnel.
- OAA Funded
- Rural
- Project Recover, implemented in Hanover, Chesterfield, and Richmond City, partners peer recovery specialists with first responders to support clients facing substance use disorders. The peer specialists educate both the individuals in crisis and the first responders about the recovery process and meet with clients in the hospital to discuss their recovery options.
- OAA Funded
- Expansion of Services
- Prince George County, Colonial Heights City, and the District 19 Community Service Board created a mobile overdose response unit and have two certified recovery peer specialists on staff. The peer specialists collaborate with law enforcement, first responders, and emergency departments to visit individuals who have experienced an opioid overdose within (48-72) hours.
- OAA Funded
- Gold Standard
- Individual Distribution
- Cooperative Partnership
- OAA Funded 2026
- City of Richmond sub-awarded local organizations to hire peer specialists. Recipients of those awards include OAR of Richmond, McShine Foundation,Saint Luke Legacy Center, Richmond Ambulance Authority and Atlantic Outreach Group.
- OAA Funded
- Expansion of Services
- Gold Standard
- Individual Distribution
- OAA Funded 2026
-
Old Dominion Court Services through Frederick County hired a certified peer support specialist to assist with pretrial services for clients. This part-time position includes providing peer support services and community resource connections.
- Individual Distribution
- OAA Funded 2027
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The EMS-initiated Buprenorphine Bridge program in Chesterfield County now includes two certified peer recovery specialists on the Mobile Integrated Health (MIH) unit, a bridge program to respond to overdose and substance-related 911 calls. The MIH unit will serve Chesterfield County and areas of Richmond City.
- Expansion of Services
- Cooperative Partnership
- Individual Distribution
- OAA Funded 2027
