Rise Recovery: Youth Addiction Services
A Youth-Centered Continuum for Sustained Recovery
Rise Recovery uses Texas opioid CORE funding to expand a youth-centered continuum that connects school-based recovery supports, an adolescent intensive outpatient program, peer-led recovery groups, family services, and on-site addiction medicine, so that young people and families in Bexar County can move from crisis or referral into sustained recovery support.
The Challenge They Were Addressing
Before Rise Recovery applied for the state opioid core contract, leadership and clinical staff were watching youth substance use grow more severe in Bexar County. Onset was earlier, polysubstance use was more common, and opioids, nicotine, and THC vaping were showing up in intake assessments at higher rates. About a quarter of participants disclosed opioids, prescription or street, as one of the substances they were using. Adolescents and young adults were also asking more questions about overdose response and naloxone, which staff read as a signal that opioid exposure was already part of their world.
Co-occurring mental health needs were significant. PHQ-9 and GAD-7 scores at intake pointed to depression and anxiety alongside substance use, and youth were cycling between emergency departments, inpatient psychiatric units, and the juvenile justice system without a clear connection to long-term recovery support. Discharge plans often consisted of a list of phone numbers and addresses, and families told Rise Recovery that the available options were not age-appropriate, were modeled on adult treatment, and were disconnected from school, peers, and family life. Transportation, scheduling, and cost limited consistent engagement, and youth said they lacked safe, sober peer communities outside of treatment hours.
When the Texas opioid core funding opportunity appeared, Rise Recovery saw a way to address those gaps by deepening a model the agency had been building for decades, rather than by starting a new program. Internal data showed strong outcomes when youth engaged in peer-based recovery programming, and a financial analysis prepared for the county judge estimated that keeping young people in Rise Recovery services for 60 days or longer would produce substantial avoided costs in the county justice system. The application was built on that evidence and the clear need for a coordinated continuum that could meet youth and families where they already were: in schools, hospitals, and at home.
What They Built
Rise Recovery is a free nonprofit recovery support organization that operates from a central San Antonio location and reaches into school districts and partner sites across Bexar County and surrounding regions. The state opioid core contract supports six staff members inside a larger agency that runs six interconnected program areas under one clinical director. Many participants are enrolled in multiple programs at the same time. A young person may attend the recovery high school, the adolescent intensive outpatient program, and a youth peer group. At the same time, a parent participates in the family group, all coordinated by a centralized screening and intake team.
Entry into services typically begins with a referral from a school, a hospital partner, community outreach, or a family self-referral. The Screening and Intake team is the first point of contact and completes a structured assessment in Lightning Step that includes the PHQ-9, GAD-7, and DAST-10, a biopsychosocial, consents, and program orientation. The participant is then matched to a Recovery Support Peer Specialist (RSPS) or a clinician and placed into the appropriate combination of services. Through weekly on-site hospital groups and close coordination with healthcare staff, the program facilitates warm handoffs into ongoing care while building familiarity and trust among patients and providers.
Inside the model, Rise Inspire Academy, the only recovery high school in Bexar County, integrates academics with recovery support during the school day, including daily check-ins, groups, academic support, and interactive learning such as culinary, therapeutic gardening, and a chess club, plus weekly off-site activities at places like the food bank, the zoo, and the bowling alley. The Adolescent Intensive Outpatient Program (IOP), which launched this year, provides individual and group counseling, recovery support, family support, and education, with therapeutic art, music, and gardening being added through new partnerships. Alternative Peer Groups (APG) offer separate ongoing peer support and groups for youth, young adults, and families, with on-site and off-site social activities designed to introduce the idea of fun in sobriety. The Community ISD program embeds counseling, prevention education, and recovery support within four partner school districts in Bexar County, with telehealth groups extending into Huffman ISD in the Houston area, Uvalde, and the Bluebonnet Trails region. The Training Institute provides RSPS, MHPS, and PSS certification training, CEU opportunities, youth mental health first aid, and tailored outreach and education sessions for partners.
On-site addiction medicine sits inside this continuum. An addiction medicine physician is physically present at Rise Recovery twice a week through a partnership with Be Well Texas, and serves participants ages 12 to 27. Visits include addiction medicine, medication management, mental health services through a Be Well Texas provider, and medications such as buprenorphine (Suboxone) and nicotine replacement therapy as clinically appropriate. Overdose prevention education and naloxone (Narcan) distribution are part of routine outreach across the youth and young adult population. Monthly status reporting back to the state opioid core team includes participants served, outreach activities, education sessions, naloxone kits distributed, addiction medicine visits, financial reporting, and any project issues encountered.
Key Program Components
Who You Need at the Table
What made a willing partner essential vs. optional?
Required partners each control something the program cannot operate without. School districts control daily access to youth, particularly for Rise Inspire Academy and the in-school IOP track, which removes transportation and scheduling barriers. Be Well Texas controls the on-site addiction medicine and medication management capacity for participants with higher clinical needs. The state opioid core contract team controls the funding and the reporting framework. Direct service staff, clinical leadership, and the screening, intake, and EHR infrastructure are what turn a referral into a coordinated set of services. Local government champions make convening, alignment, and continued funding support possible at the city and county levels.
Helpful partners deepen the model without sitting at its center. Psychiatric hospital and behavioral health partners began as referral sources, and Rise Recovery and the hospital teams later co-developed on-site groups so that, by the time a young person is preparing for discharge, they already know a Rise Recovery face. Depending on each hospital's capacity, those groups run weekly, biweekly, or monthly. Community-based organizations, juvenile justice partners, workforce development partners, and outside grant writers each extend reach, sustainability, or application strength. Telehealth partner districts and authorities extend the model outside of Bexar County without requiring new physical sites.
Budget Breakdown
What is the minimum viable budget to replicate this?
A county or community starting from scratch with a smaller settlement award can adopt the underlying logic of this model without recreating the full Rise Recovery footprint. The minimum viable version is one full-time direct service staff member, either an LCDC or an RSPS, with salary and fringe fully funded, plus a small budget for outreach materials (flyers, brochures, business cards), travel and mileage reimbursement, and basic technology (a laptop, a phone, and a documentation and data system). An LCDC costs more than an RSPS but brings clinical licensure; the choice depends on what the local model needs most. Beyond a single FTE, additional staff capacity enables the program to serve more participants without burning out the team. Direct service staff is the line that cannot be cut. Marketing, outreach, and program promotion strengthen reach but can be scaled back if dollars are tight.
What Worked and Why
Specific decisions or design features that drove success
Building on what already worked, rather than starting over, let Rise Recovery move quickly when the state's core funding became available. The agency did not invent a new service line; it applied national best practices, including Alternative Peer Groups, recovery high schools, and peer recovery coaching, and aligned them into a single continuum tailored to Bexar County. That alignment with frameworks from groups like the Association of Recovery Schools and the Association for Recovery in Higher Education strengthened the application and accelerated implementation.
Designing services around the school day removed the most common barriers to engagement for young people. Rise Inspire Academy integrates academics and recovery into a single daily schedule; the IOP offers an in-school track alongside afternoon and evening options; and the Community ISD program embeds counselors and peer specialists directly on partner campuses. Transportation, attendance, and scheduling stop being the reasons a young person drops out of services.
Centering peer recovery support inside the model gave the program a way to keep youth and families engaged across levels of care. All program staff are themselves in recovery, and Rise Recovery has hired graduates of the recovery high school into staff roles. That lived experience builds trust faster than paperwork can, and it shows up in everything from the way intake feels to the way young people respond to the addiction medicine physician.
Shifting from a referral-only relationship with psychiatric hospitals to delivering on-site groups inside those hospitals turned discharge into a relationship rather than a list. By the time a young person is ready to leave inpatient care, they have already seen Rise Recovery staff in the hospital, know the program by name, and are willing to walk into the next level of support. The cadence of those on-site groups, weekly, biweekly, or monthly, is matched to each hospital's capacity rather than imposed.
Adding an on-site addiction medicine physician through Be Well Texas closed the last gap in the continuum. Participants ages twelve to twenty-seven can receive addiction medicine, medication management, mental health services from a Be Well provider, and medications such as buprenorphine and nicotine replacement without leaving the building. Combined with centralized screening and intake, this lets a single intake flow connect a young person to school-based services, IOP, peer groups, family services, and medical care in one coordinated arc.
Early outcomes and data
1,538 total participants served across all Rise Recovery programs since the current grant period began.
FY25 service volume of 1,139 participants reported on the project snapshot.
About 25 percent of participants reported opioids as one of the substances used at intake, supporting the targeting of the core contract on this population.
Ten Rise Inspire Academy seniors graduated with a diploma in the most recent school year, with more than half going on to college and several to specific training programs; six are scheduled to graduate in the current school year.
Monthly status reporting to the state opioid core team consistently captures participants served, outreach activities, education sessions, naloxone (Narcan) kits distributed, addiction medicine visits, financial reports, and any project issues encountered.
Internal CFO analysis estimates high avoided costs to Bexar County in justice-system, court, and incarceration spending for participants who stay in services for sixty days or longer or reach a sobriety milestone.
The state opioid core team visited Rise Recovery on site and featured the program in its newsletter; Rise Recovery is presenting to the state roundtable on its use of core funding.
All program staff are themselves in recovery, and graduates of Rise Inspire Academy have been hired into staff roles, supporting a peer-led service model.
By helping youth and young adults remain engaged in the Rise Recovery program and achieve 60 or more days of recovery and/or sobriety, the program has the potential to generate up to $2.1 million in annual savings for Bexar County while reducing justice system involvement.
Lessons Learned
Set up billing and documentation early. Aligning documentation to payer requirements, training staff on the EHR, and standing up billing workflows took longer at Rise Recovery than anticipated. Counties replicating this work should treat billing and documentation as launch-blocking priorities rather than post-launch tasks.
Choose one EHR quickly and optimize it. Extensive comparisons across multiple platforms cost time without improving outcomes. Make a thoughtful but timely decision and direct the saved energy toward configuring the system for assessments, treatment planning, reporting, and cross-program coordination.
Track grants and metrics before reports come due. When an agency runs multiple grants, dedicated tracking of due dates and required outcome measures is essential. Build the tracking system at application time, not the week before a report is due.
Braid funding deliberately and stay in compliance. A diverse revenue portfolio insulates the agency if any one source ends, but it also requires careful tracking to ensure positions are fully funded across sources without double-dipping. Build the braided funding plan with finance leadership from the start.
Build relationships with local government champions. Long-standing relationships with city and county leaders, including a county judge who asks about justice-system avoided costs, create the conditions for sustained funding and convening power. Invite these leaders to program events, so they see the work firsthand.
Use hospital and behavioral health partners for warm handoffs. Moving on-site into psychiatric hospitals, even once or twice a month, gives patients a familiar face before discharge and turns a list of names on a discharge sheet into an actual next step. Match cadence to each hospital's capacity rather than asking for more than the partnership can sustain.
Hire direct service staff with lived experience. Peer recovery support specialists and clinicians who themselves are in recovery are the engine of the model. Counties planning a youth-focused continuum should treat lived experience as a hiring priority and pair it with the credentials each role requires.