• Take some time to (re)discover your ROOTS!

  • Welcome Home!

    From the bottom of our hearts, we want to welcome you to Roots Wellness Center! Our hope is that you will come to view Roots as your new “home” for health & wellness services, support, advocacy, encouragement, and anything else you need on your recovery journey.

    Building a beneficial relationship with you is our top priority, as we believe that meaningful connections to other like-minded individuals are the foundation of recovery. Strengthening the quality of our relationship, and helping you build a broader network of recovery support are fundamental goals of the Roots Wellness Center treatment program. We hope to accomplish this goal by listening to and responding to your needs, challenges, and triumphs; and we look forward to walking along side you through this process.

    Roots Wellness Center also aims to enrich the communities we serve, and we’re committed to honoring the traditions and values of those communities. For that reason, we’ve built a recovery program with one goal in mind: to help you build the strong roots you need to thrive by utilizing the natural support systems and resources already available in your community. Please let us know if you need assistance with referral to, or coordination of care with your favorite clinic, doctor, therapist, support group, or case manager. We are here to enrich your recovery journey.

    Please let me, or any of my staff know if you need anything; we are always available to help!

    We are grateful that you’ve chosen to continue your recovery journey
    at Roots Wellness, Where Recovery Grows!

    Sincerely,

    Elizabeth Jacobson, LADC
    Program Supervisor

  • Adult Intake Information

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  • Releases of Information

    Please include contact information when applicable
  • Housing Information

  • Emergency Contact Information

  • Peer Support Recovery Needs Checklist

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  • Treatment Coordination Recovery Needs Checklist

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  • Roots Housing Stipend Program

    Client Participation Agreement
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  • Client Agreement

  • RWC has agreed to provide a housing stipend incentive in the amount indicated above to the sober residence identified above on your behalf for the duration of your participation in the intensive programming phase of the Roots program.

    The availability of this stipend is dependent on your agreement with and adherence to the guidelines and expectations in this agreement. RWC reserves the right to terminate payment of the housing stipend at any time, at its own discretion, but will generally only take such action if you are discharged from the treatment program (whether by your own decision, or at the program’s request), do not meet the requirements of this agreement, or are otherwise deemed ineligible.

  • Payment Procedures & Amounts

  • • The housing stipend is only available to clients in the high-intensity outpatient program.

    • Additionally, the housing stipend is only available to clients who attend, and for whom the program receives payment/reimbursement for the minimum number of hours of group treatment programming required for their specific phase each week.

    • Each client must complete an initial “Assessment Phase” before becoming eligible for the stipend. During this period, which is the first two weeks of their treatment process starting with the date of intake, the client must attend and complete their
    comprehensive assessment, mental health diagnostic assessment, initial nutrition assessment, and attend all scheduled group sessions during that period. If the assessment phase is completed successfully, the program will pay the stipend starting with their intake date. If the assessment phase is not completed successfully, the program reserves the right to deem the client ineligible for the housing stipend incentive.

    • Payments are made to sober residences retroactively by the 5th of the month for the previous month. If a client admitted part way through the previous month, the payment will be pro-rated back to the date the client started programming.

    • Payment amounts are based on the client’s current phase (a base rate) and participation (adjustments). The program pays the percentage of groups attended by the stipend amount for up to $450 in Phase 1, for example, and an additional $100 for 2 mandatory 1:1 sessions per month during the eligibility period up to the maximum amount for that phase. If the client attends all the required hours in a week, they will receive the entire stated base amount for that week.

    • Base stipend amounts are based on the client’s phase during the eligibility period. Those amounts are as indicated below:

    Phase Group Hours Required Weekly Base Incentive Amount
    Phase 1 - Full Stipend   19 groups, 2 1:1s $550
    Phase 2 - 3/4 Stipend 16 groups, 2 1:1s

    $400
    Phase 3 - 1/2 Stipend 19 groups, 2 1:1s

    $275
    Phase 4 - 1/4 Stipend 10 groups, 2 1:1s

    $140
    Assessent Phase First two weeks of programming   Stipend Withheld
  • Client Expectations & Obligations

    • Clients must attend all individual counseling/therapy sessions (including nutrition counseling, peer recovery support, Kai Shin psychiatric and treatment coordination appointments) and requested drug tests during a programming week in order to maintain eligibility for the stipend during that week. A client who misses more than two individual sessions or requested drug tests (whether in clinic or at home collection) may be deemed ineligible for the housing stipend.

    • Clients should keep track of their hours to ensure continued eligibility, and to plan for makeup sessions for any missed programming. Missed groups must be made up during the same week they are missed, without exception.

    • Clients must get permission from the program in order to change sober residences during their treatment engagement. If they do not get this permission, they may not receive payment for a new residence not indicated on this agreement.

    • Clients are solely responsible for any sobriety/security deposit, any monthly overage amounts (as indicated above) as well as any additional program fees charged by the residence.

    • RWC may, at our discretion, institute a tiered stipend system, which means that the program may elect to lower the stipend amount paid on your behalf over a period of weeks or months in order to allow you to start paying more of the fees yourself as you gain independence. The program will inform you of this prior to changing the stipend amount.
  • Standards of Conduct:

    • Clients staying in a sober residence paid for by RWC must follow all rules and expectations of the sober residence, and actively work a program of recovery during their stay.

    • Clients should understand that peer support staff, counselors, treatment and intake coordinators, and other RWC staff seek to maintain regular contact with sober houses to ensure safety and accountability.

    • Clients should display appropriate and respectful behavior at all times, ensuring that they are representing RWC program in a positive manner.

    • Clients must maintain open communication with the sober residence staff and Roots Recovery staff and work proactively to resolve any disputes or conflict
      they may be experiencing
      with said staff, group peers, and residence peers.

    • Clients should immediately report any unsafe conditions, behaviors or actions displayed by other Roots clients, residence peers, or treatment and sober residence staff to the program director and/or RWC staff member.

    • Clients may not serve as sober house leaders (paid or unpaid) while in programming at RWC if another RWC peer lives in that house. This can create an unsafe environment for those peers within the group dynamic.

    • Clients must inform the RWC program immediately if they experience a lapse on substance use and/or are at risk of being asked to leave the sober residence.

    • Clients will not bring drugs, alcohol, paraphernalia, weapons or any other disallowed items into their sober residence, nor enter into romantic or sexual relationships with any of their sober residence peers.

    • Clients must maintain appropriate boundaries in all peer and staff relationships and seek to build positive and supportive relationships with group and residence peers and staff.
  • Release from Liability & Hold Harmless Agreement:

  • By signing this form, you indicate an understanding that participating in treatment and living in a sober residence comes with increased risk than other living situations. You are agreeing to assume that risk of your own volition. You further hereby agree to indemnify and hold harmless the RWC Program from any loss, liability, damage or costs, that you may incur as a result of participation in the treatment program and living in the sober residence. This statement does not include any loss for which you are guaranteed protection (maltreatment, neglect, etc.) in accordance with state and federal statute.

  • Discharge/Move-Out:

    • Clients must inform RWC program staff of any decision to move out of a sober residence for which they are receiving a stipend within 24 hours of such a decision. This notification can be made by calling or texting their counselor, sending an email to roots@rwc-mn.com, or leaving a voicemail in our general mailbox at 612-564-5933.

    • Clients who are discharged from the RWC treatment program must immediately inform the sober residence of their discharge from treatment and make arrangements to take care of any ongoing residence program fees. Roots Recovery does not pay housing stipends for clients after they have been discharged from the high intensity treatment program.

    • Clients agree to remove all of their personal property upon move-out from the sober residence, and to refrain from removing any property from the residence that does not belong to them. Clients must immediately return any property belonging to residence peers or staff upon finding it in their possession.
  • Changes & Amendments to this Agreement:

    • RWC reserves the right to make any amendments to this participation agreements as it deems necessary and will inform the client of any such changes. The program may ask the client to sign an amended agreement at any time. Clients must comply with this request in order to remain eligible for a stipend payment.

    • This agreement does not represent a complete and comprehensive list of client expectations, but rather a general overview. RWC reserves the right to make verbal amendments to this agreement whenever such an amendment is necessary to protect its property, clients, and clinical integrity.

    • In addition to the terms of this agreement, clients receiving a housing stipend must also ensure they are complying with all of the RWC Program Rules & Expectations, a copy of which they received during intake. Continued adherence to those Rules & Expectations is expected throughout the client’s involvement in the treatment program and sober residence.

      By signing this agreement, you attest that you understand the terms of this agreement, that you are financially capable of paying any overage amounts during your stay in the sober residence, and that you are entering this agreement willingly. Furthermore, you agree to abide by the terms of this agreement throughout your participation in the program.
  • Client Signature

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  • Roots Recovery Housing Stipend Agreement

  • Telehealth Consent Form

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    Minnesota CarePartner/Roots Recovery allows, under certain conditions, the use of Telemedicine technology for Therapy and Skills sessions at the provider's discretion and with the patient/client consent. Telemedicine is not intended to be a complete replacement for face-to-face sessions and face- to-face sessions are expected to remain the primary mode of service.

    Acceptable reasons for the use of telemedical include such things as: Severe weather or transportation barriers making it difficult to travel to your therapist's office, having to remain in home due to ill child, public health crisis, having your ride cancel at the last minute, scheduling conflicts or being out of town. Keep in mind, however that there might be certain clinical, ethical, or legal factors that would preclude or limit the use of Telemedicine. Your provider will discuss these factors with you on a case-by case

    If you agree to participate in some sessions through telemedicine, please be reassured that all the standard issues related to privacy and confidentiality will still apply. However, please be advised that telemedicine uses the internet, which is not as secure as the privacy of your provider's office and certain service providers might store copies of videos. It is possible that communication might be intercepted (hacked) or otherwise compromised. Additionally, telemedicine being a relatively new format, the empirical evidence for its efficacy, while promising, is limited.

    Also, be aware that if you elect to not use telemedicine for therapy, this will not affect your ability to continue scheduling face-to-face sessions with your provider as available. Please ask your particular provider how telemedicine sessions factors into the no show, and late cancelation policy.

    I agree to engage in sessions through telemedicine. I am aware of the potential limitations to privacy, confidentiality and service connections associated with telemedicine.

    I agree that I will take responsibility to ensure that I am in a place that allows sufficient privacy when engaging in telemedicine, and that I will take every precaution to ensure that my confidential health information is protected on my end of the telemedicine connection.

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  • Getting to Know You

    Thank you for completing our paperwork so that we can get to know you and ways that you would like us to help you. Please let us know if you have any questions.
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  • Medical Needs

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  • Substance Use History

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  • GAINS-SS Assessment

    Please indicate if you have experienced the following concerns:
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  • Mental Health

    We know this is personal, please share what you are comfortable with.
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