Continuum of Care Recovery for Justice-Involved Adults
A Continuum-of-Care Model Bridging Residential Treatment, Workforce Training, and Transitional Housing
The Shoulder of the Central Gulf Coast, a Gulf Coast nonprofit founded in 1985, runs an 82-bed residential substance use treatment program for adults across two Alabama campuses and is using four rounds of opioid settlement funding to evolve from supplemental medication-assisted treatment enhancement into a comprehensive continuum that pairs stabilization with workforce training, career placement, and transitional housing for justice-involved adults with opioid and stimulant use disorders.
The Challenge They Were Addressing
For most of its history, The Shoulder of the Central Gulf Coast operated as a traditional residential substance use treatment program: people came in, stabilized, completed a 30- to 90-day course of care, and left. The model worked for many, but the team watched a recurring pattern emerge as the opioid and fentanyl crisis intensified along the Gulf Coast. Clients would leave with strong clinical foundations and then return to the same neighborhoods, the same employment gaps, and the same housing instability that had contributed to their use in the first place. Several clients died of fentanyl overdose in the weeks after discharge, and each loss made the same case: residential care, on its own, was no longer enough.
The agency also faced a population-fit problem. When the first opioid settlement allocation arrived, the funding was narrowly scoped to opioid users, who made up only about 20 to 25 percent of Shoulder admissions. The majority of clients arrived with stimulant use, often combined with opioids, and the team needed a more flexible structure that could serve the people actually walking through the door. At the same time, the women’s campus in Mobile County faced a temporary funding gap during a transition between other revenue sources, threatening continuity of care for women already in treatment.
Looking further down the continuum, the team kept hearing the same questions from clients preparing to leave: where will I live, and what work can I do that pays enough to stay in recovery? Local employer partnerships were beginning to produce job placements, but most positions were entry-level and offered limited opportunities for advancement. Transitional housing was scarce, and what existed was operated by a patchwork of partners with varying levels of recovery support. The Shoulder team concluded that the next phase of the work should extend beyond stabilization to include workforce training, career placement, and agency-run transitional housing, with each component designed around the realities of justice-involved adults in early recovery.
What They Built
The Shoulder operates an 82-bed residential treatment program across two Alabama campuses: 40 beds for men in Spanish Fort in Baldwin County, and 42 beds for women in Mobile in Mobile County. The agency offers high-intensity residential, low-intensity residential, transitional levels of care, and a new outpatient Level 1 service. Medication-assisted treatment is delivered with Suboxone, Sublocade, and Vivitrol, with a clinical preference for injectable formulations that reduce the need for daily-dose decisions during early recovery. Screening uses the UNCOPE tool, and clinical assessments produce the 910 yearly intakes that feed the 246 admissions reported in 2025.
Opioid settlement funding from the Alabama Department of Mental Health (ADMH) has moved through four planned rounds. Round 1 supported a supplemental medication-assisted treatment enhancement limited to opioid users. Round 2 expanded eligibility to people with opioid and stimulant use, which together account for roughly 85 to 90 percent of Shoulder admissions, and was applied as a primary funding source for approximately six months to bridge a temporary funding gap at the women’s campus and keep services uninterrupted. Round 3 funds both campuses for a longer-term comprehensive model that links stabilization with case management, identification and legal support, employment placement, and employer partnerships. Round 4, currently in development, will fund the full continuum, including workforce training, career placement, and agency-run transitional housing.
Operation Vets, launched in 2025, adds a veterans track delivered in partnership with the state veterans community. The program uses the new outpatient Level 1 service line, employs a veteran counselor, and is led by an Executive Director who is also a veteran and a therapist. Operation Vets has built referral relationships with Rotary Clubs and local Veterans Affairs chapters and is actively recruiting a veteran peer in long-term recovery to round out the peer support model.
The Round 4 vision extends the continuum into workforce training and transitional housing. The agency is building short-course certificate tracks ranging from 2 weeks to 3 months in fields such as welding, heavy equipment operation, and culinary arts, designed to help clients move from holding jobs to building careers. Agency-run transitional housing will close the back-end gap clients have repeatedly identified, complementing existing recovery housing partnerships with Oxford House, Alliance Recovery Housing, and several individual community-run homes.
Key Program Components
Who You Need at the Table
What made a willing partner essential vs. optional?
The required partners are the ones that move clients into care, keep the program funded, and place clients into safe environments after discharge. The Alabama Department of Mental Health is the financial backbone of the opioid settlement work and of Operation Vets; without those allocations, the continuum expansion could not move forward. Drug courts, the District Attorney’s Office, and Veterans Court are the front door for the justice-involved population the program is designed to serve. AltaPointe Health and the regional behavioral health system provide the co-occurring mental health care that many clients also need. Local employers and recovery housing partners are required because they hold the two pieces of post-discharge stability, work, and a safe place to live, which recovery cannot survive without.
Helpful partners extend reach and add specialized capacity. Goodwill, Aletheia House, Genesis, First Step, and the broader Alabama peer-provider network exchange referrals when a client's need aligns with another agency’s strengths. The Rotary Clubs and local Veterans Affairs chapters give Operation Vets visibility and trust within the veterans community. Department of Human Resources offices and CED help coordinate family and economic support cases. The program could open without any individual helpful partner; it could not open without the funder, the courts, and the access points that bring justice-involved adults into care.
Budget Breakdown
What is the minimum viable budget to replicate this?
A residential or outpatient provider already operating a 25- to 30-bed treatment program can begin evolving toward this continuum model for an additional $250,000 to $400,000 per year. The non-negotiable line items are: a small case management team to handle identification, legal, and employment needs; at least one certified recovery support specialist on staff; medication-assisted treatment access on-site or via a formal partnership; and at least one workforce or employer partnership that connects clients to paid work during treatment. Transitional housing and formal training certificates can be phased in once the case management and employer linkages are running.
What Worked and Why
Specific decisions or design features that drove success
Expanding the opioid settlement scope from opioid-only to opioid-and-stimulant after Round 1 was the decision that aligned the funding with the population. With opioid users at roughly 20 to 25 percent of admissions and stimulant or polysubstance users at the majority, Round 1’s narrower scope limited how broadly the dollars could be deployed. Round 2’s expansion enabled the team to apply settlement funding to roughly 85-90% of clients, improving outcomes and giving the agency the flexibility to allocate dollars where clinical need was greatest.
Using Round 2 as a primary funding source to fill a temporary funding gap at the women’s campus preserved continuity of care during a transition between other revenue streams. Closing the women’s campus, even briefly, would have meant turning away women already engaged in treatment. Routing settlement dollars to keep the doors open for approximately six months gave the agency time to stabilize the campus’s longer-term funding stack without disrupting client care.
Building case management for identification, legal, and employment alongside clinical care addressed the practical reasons clients leave treatment and return to use. Replacement identification, court compliance, and a job lined up before discharge are not clinical interventions, but they are the scaffolding that lets clinical gains hold after discharge.
The decision to shift from job placement to career building shaped the design of Round 4. The team saw clients succeed in entry-level positions, only to plateau at wages too low to support stable housing and family responsibilities. Short-course workforce training certificates (welding, heavy equipment, culinary) target sectors with clear wage ladders in the Gulf Coast labor market, with completion timelines (two weeks to three months) that fit inside the treatment and transitional housing window.
Operation Vets launched as part of the total $600,000 annual award. Per ADMH, unused funds roll over into the next year. The program includes an outpatient track with veteran clinical and peer leadership, allowing the agency to serve veterans with the cultural specificity the population requires, without retrofitting existing residential programming. Veterans Court, Veterans Justice Outreach, Rotary Clubs, and local Veterans Affairs chapters are the program's target audience because Operation Vets is built around them, not bolted onto a general adult model.
Early outcomes and data
246 individuals were admitted in 2025 from 910 assessments completed across 32+ Alabama counties.
Client demographics: 137 women (approximately 56 percent) and 109 men (approximately 44 percent); average age 39.
Substance use profile: methamphetamine and amphetamine present in approximately 61 percent of admissions, opioids in approximately 31 percent, with polysubstance use common.
Social determinants at intake: approximately 26 percent reported homelessness, approximately 54 percent unemployment, and approximately 67 percent had children.
Priority and high-need cases: 139 clients (approximately 57 percent) flagged as priority or high-need at intake.
Operation Vets served 10 veterans in its initial months, with an annual budget of $600,000 expected to expand the population reached through 2026.
Sample post-discharge employers include Sonic, Circle K, Kimberly-Clark, McDonald’s, Steiner Construction, and Publix, as part of the Round 4 career-track expansion.
Lessons Learned
Know the gap before you apply. Each round of opioid settlement funding worked because The Shoulder could name a specific clinical or structural gap that the dollars would close. Funding sought in the abstract tends to scatter across competing priorities; funding tied to a documented gap moves the program forward in a measurable way.
Match scope to population. When Round 1 was narrowly scoped to opioid users, the dollars served only a fraction of clients. Round 2’s expansion to opioid-and-stimulant care aligned funding with the people walking through the door and allowed the agency to apply resources where the clinical need was greatest.
Build the back end with the front end. Stabilization is necessary but not sufficient. Workforce training, employer relationships, and transitional housing matter as much as the residential bed, and clients ask about all three before they ask about clinical content.
Plain tools done consistently beat sophisticated tools done occasionally. The Shoulder runs program data through spreadsheets and basic electronic records. Consistency, accuracy, and time series matter more than software brand, and a small agency can compete with much larger ones on data quality if it commits to the routine.
Veterans peers must be veterans. Operation Vets is built around veteran clinical and peer leadership, and the program is actively recruiting a veteran in long-term recovery to complete the peer model. A non-veteran peer cannot carry the same credibility with veterans, worried about career consequences and stigma.