The Roanoke Refuge admissions process.

The Call Families Put Off the Longest

This is the call families put off the longest. The longer you wait, the harder it gets, and we know what it took for you to be on this page right now. The decision to seek addiction treatment is one of the most significant decisions a person can make, and one of the most frightening. The last thing a family needs at that moment is a confusing, bureaucratic process that creates more barriers than it removes. Our admissions process is designed to be clear, fast, human, and as simple as we can make it while still completing the thorough clinical assessment that good treatment requires.

Whether the call is for yourself or for someone you love, the process below is the same. Our treatment approach describes the clinical model that admissions leads into, and the level-of-care recommendation that comes out of admissions is grounded in evidence-based clinical standards.

Step 1: The First Call

The first call sounds bigger than it is. You pick up the phone, somebody answers, you tell them what is going on as much as you can, they ask a few questions, you hang up with a clearer picture. That is the whole thing. No commitment, no enrollment, no paperwork. Just a conversation. You do not have to know what to say. The first call costs nothing and obligates nothing. It is a confidential conversation with a member of our admissions team trained to listen, not to sell. You can call on behalf of yourself or a family member. You can be in the middle of active use. You can be scared or uncertain. None of that changes how we respond.

We will ask basic questions about the situation, including what substances are involved, how long the use has been a problem, whether there are immediate medical concerns (active withdrawal, other health issues), and the current living situation. The information helps us determine whether our programs are the right fit, and if not, to help connect the family with what is. If we are not the right fit, we will tell you that out loud, and we will help you find what is.

Step 2: Insurance Verification

Insurance is the conversation families dread most. The plan language is opaque on purpose. The cost-share calculations require a calculator. We run that part for you, free of charge, before you ever commit to a clinical decision. The conversation takes approximately 15 to 30 minutes. We call the insurance company on the client's behalf, determine coverage for PHP and IOP, calculate the estimated out-of-pocket costs, and review all of it with the family before any commitment is made. No fine print. No surprises. Our insurance and payment overview walks through federal parity, plan categories, and options for clients who are uninsured or Medicaid-eligible.

Step 3: Clinical Intake Assessment

This is the part that worries families most because it sounds clinical and final. It is not. The intake is a conversation about your life with somebody whose job is to listen carefully enough to make a good recommendation. The clinical intake assessment is conducted in person by a licensed clinician and takes 60 to 90 minutes. The assessment covers:

• Substance use history: What substances, how much, how often, for how long, and any prior treatment episodes.
• Mental health history: Prior diagnoses, current symptoms, treatment history, and current medications.
• Medical history: Physical health conditions, current medications, and withdrawal risk factors.
• Social and family history: Family structure, relationships, trauma history, and social support.
• Functional assessment: Employment, housing, financial situation, legal status, and childcare.
• Motivation and readiness: Stage of change, prior recovery attempts, and personal goals.

We use items from validated assessment instruments alongside the clinical interview, including the AUDIT for alcohol screening, the DAST for drug screening, and depression and anxiety screening items drawn from the PHQ-9 and GAD-7, plus a clinical framework for level-of-care determination.

Step 4: Level of Care Determination and Treatment Planning

Following the intake, our clinical team reviews findings and determines the appropriate level of care. The recommendation is PHP, IOP, or a referral to a higher level of care if clinical needs exceed outpatient capacity. For clients who need medical detox first, our admissions team coordinates the off-site detox handoff with local partner providers. We communicate the recommendation clearly, explain the clinical reasoning, and develop the initial treatment plan collaboratively with the client.

Step 5: Your First Day

The dread before the first day is universal. We know it, and we plan for it. You will meet your primary therapist, be introduced to the group, review the program schedule, and begin the first session. You will not be thrown into the program without context or support.

What Happens on Day One

One of the most-searched questions from people preparing for treatment is what actually happens on the first day, and we get it. You are about to walk into a room you have never been in and trust people you have never met with the hardest parts of your story. Here is the honest answer:

• Before arrival: Insurance verification is complete, the initial intake assessment is complete, and the primary therapist has reviewed the assessment summary. A space has been reserved in the program cohort.
• Arrival and orientation (approximately 30 minutes): The client is greeted by the primary clinician or an admissions staff member, completes any remaining paperwork (consent forms, HIPAA acknowledgment, program agreements, release-of-information forms when applicable), receives a printed or digital program schedule, and is given a tour of the facility.
• Meeting the primary therapist (30 to 45 minutes): A brief individual check-in with the therapist on day one. This is not a deep clinical session. It is a relational introduction, a chance for the therapist to meet the client where they are, answer immediate questions, and set the tone for the therapeutic relationship.
• Introduction to the group: The client is introduced to the group cohort in a way that respects their comfort level. Sharing the full story on day one is not required.
• First group session: Participation at whatever level feels manageable. Some clients share extensively on day one and many do not. Both are fine.
• End of day: The therapist or case manager checks in briefly before the client leaves for the day. Any logistical questions, including parking, next-day schedule, and whom to call with questions overnight, are addressed.

By the end of day one, the client knows the space, knows the primary therapist, has a schedule in hand, and has taken the single most important step in recovery: showing up. Many of the clients who walked into that first day terrified later describe it as the moment something finally let go.

What to Bring to the Intake Appointment

• Photo identification: Driver's license, state ID, or passport.
• Insurance card or Medicaid ID: Both medical and behavioral health insurance details.
• Complete list of current medications: Including dosage and prescribing physician.
• Prior treatment records: Intake assessments, discharge summaries, psychiatric evaluations.
• Emergency contact information: For at least one family member or close support.
• Method of payment: For applicable copays or self-pay amounts discussed during the verification conversation.

Confidentiality

Everything shared during admissions is protected by HIPAA and additionally by 42 CFR Part 2, which provides stronger privacy protections specifically for substance use disorder treatment records than standard medical privacy law. We cannot confirm or deny that you are a client without written consent, with very limited exceptions for emergencies.

If You Need Detox or MAT First

Clients who are physically dependent on alcohol, opioids, or benzodiazepines typically need medically supervised detox before starting outpatient treatment. Medically supervised detox happens with our partner providers in the Roanoke Valley before PHP or IOP begins. Our admissions team coordinates the referral and arranges direct admission into PHP or IOP once the client is medically stable. MAT for opioid use disorder is prescribed on-site by the Roanoke Refuge medical team (Suboxone and buprenorphine). Clients already established with an outside prescriber can continue that relationship or transition to our medical team during admissions.