610 N Dustin Ave
Farmington, NM 87401
Cell (505) 360-4672
Office (505)325-9205
Mission Statement
To provide people recovering from substance abuse a safe, secure home in which to live and
to practice the skills taught to them in treatment, so that they may become productive
members of their community.
Vision Statement
We visualize that recovering people will use this home as a daily starting off point. They will
learn and practice to use skills in many areas such as living, recovery, employment, parenting,
educational, relationships, financial management, and spiritual principles. Because they live
in a group situation, they will learn and understand that their contribution can make a
difference and they do matter as a person and as a member of a community.
Masada House Services
Provisions of shelter, utilities, some food, support, case management, supervision, and life skills
are provided to our clients.
Group meetings provide support and education including:
• Relapse prevention
• Communication skills
• Boundaries
• Recovery meetings
• Substance abuse education
• Stress Management
• Relaxation
• Refusal skills
• Financial Management
• Self-care issues
• Self Esteem
• Social activities
There are recreational opportunities at the home and throughout the community.
Residents learn to develop goals to sustain sobriety and a healthy, independent lifestyle
utilizing community support agencies, support networks, local businesses, housing initiatives,
religious communities and the education systems of San Juan County.
RULES AND RESPONSIBILITIES
We are glad you are considering Masada. It is a place where you can relax, have fun, work your
program, and be kind to yourself and others. Here are a some of the basic rules we follow to
keep it a safe environment for everyone. You will receive a Client Handbook with a more
detailed list when you arrive. You and your welfare are very important here, as is everyone else
in the house. Our common welfare comes first.
Masada House transitional program is a privilege and NOT a right. By applying for and being
accepted into this program you are saying you want to be here to achieve long-term continued
sobriety. To stay in the program, you must comply with the program rules.
RESIDENT RESPONSIBILITIES
1. Program fees are $500 a month, payment arrangements may be set up with staff.
2. The Masada program comes first before personal business.
3. Maintain a positive attitude this is important to change your perspective.
4. Communicate honestly.
5. Please notify staff when you are
sick.
6. Comply with program requirements.
7. Take direction/suggestions from staff.
8. Keep the names of other residents confidential.
9. You are responsible for your personal property.
10. You will be financially responsible for the cost of repair or replacement if you intentionally destroy or deface property.
HOUSE RULES
(PHONES ARE NOT ALLOWED DURING HOUSE MEETINGS AND MEDITATION)
1. Residents must wake up on time 7 am M-F
2. Make your bed
3. Meditation is at 7:30 am Mon-Fri and at 8:00 am on Sat.
4. House meetings are on Sundays at 4 p.m.
5. Chores must be done immediately after meditation Monday-Friday and by 12 p.m. Saturday and Sunday.
6. Wash your own dishes.
7. Arrangements for visitors must be made in advance with staff.
8. Visits to the jail are not allowed during Level 1.
9. Smoke only in designated areas.
10. No gambling per probation restrictions.
11. We do random UAs and BACs.
12. Call in every 3hrs Level 1&2 and 5hrs for 3&4.
13. Sign Out/In When you leave and when you return.
14. Curfew:
Level 2, 3, & 4
Sunday- Thursday 10:00 p.m.
Friday and Saturday 11 p.m.
Level 1 residents
must return to the house after
meeting or another requirement is
complete.
15. Overnight passes may be granted during levels 3 and 4 if you meet all requirements.
16. Residents must attend at least 3 support meetings per week.
Levels of Success
Masada House residential program has 4 levels. Each phase earns additional privileges. Focus
on completing the phases. As long as there are no major infractions within the 30 days and you
are current on fees you may move up a level.
Level 1: First Thirty Days
• Obtain a sponsor
• Obtain a Job appropriate to your individual treatment plan
• 3 meetings a week
• No house restriction within 30 days
• Attend all case management meetings
• Follow the treatment plan
• Make arrangements for payment of restitution, bills, and Masada program fees
• Follow house rules
• One 2-hour or less shopping period per week. The week runs from Sunday to Saturday. Additional time may occasionally be allowed for haircuts. Speak with staff.
Level 2: 30 days
• Able to attend activities and social
events
• Working with a sponsor/mentor
• 3 meetings a week
• No House Restriction within 30 days
• Job search continues, appropriate to
your schedule
• Actively working on goals
• Following house rules
• Following treatment plan
Level 3: 30 days +
• Continuing to work with a sponsor/mentor
• 3 meetings a week
• No House Restriction for 30 days
• Following treatment plan
• Fees paid on time
• Maintaining a job- or securing employment
• Saving money for future goals (housing, car, etc.)
• Restitution and bills continue to be paid
• Actively working on goals
• Following house rules
• Able to apply for overnight pass
• Fees paid on time according to payment plan
• Restitutions and bills being paid on time
• Actively working on goals
• Following house rules
• Following treatment plan
Level 4: Transitional Level
• Continuing to be compliant with allrules and responsibilities
• Able to apply for overnight passes
• Finding permanent housing
• Safety-Exit plan developed
• Fees up to date
• Support network meeting-if needed to meet and discuss progress and discharge plan
Referral Form
Referral Date: Text field Name: Text field
Ethnicity: Hispanic/Latino
Radio buttons
Veteran:
Radio buttons
Race:
Checkboxes
If you checked Race Other please describe: Text field
Age: Text field
SS Number (last 4): Text field
Physical Address: Text field
Mailing Address: Text field
Phone: Text field
Emergency Contact: Text field
Phone: Text field
Referring Agency
Name of Agency: Client Referred By
Name of Contact: Text field
Phone: Text field
Address: Text field
Reason for the referral: Text field
Does client have any legal cases?
Radio buttons
Has client been sentenced?
Radio buttons
Is client currently incarcerated?
Radio buttons
Where: Text field
Name of Judge: Text field Docket #: Text field
Nature of Charges: Text field
Probation expiration date: Text field
Name of last treatment center: Text field
When: Text field Where: Text field
Drug(s) of Choice? Text field
Is the client on a drug therapy program (suboxone, methadone, THC)?
Radio buttons
Are there plans to put them in such a program?
Radio buttons
Please submit the judgment and sentence. Email to stopanijj@gmail.com
GENERAL INFORMATION
Name: Client first name Client last name
Have you served in the military:
Radio buttons
Phone: Client phone
Address: Client Address
City: Client City State: Client State Zip: Client Zip
Date of Birth: Client birthdate
SS Number (last 4) xxx-xx- Text field
Message/Emergency Contact:
Name: Contact 1 name Relationship: Contact 1 type
Phone: Contact 1 phone Email: Contact 1 email
Name: Contact 2 name Relationship: Contact 2 type
Phone: Contact 2 phone Email: Contact 2 email
What is your marital status? Text field
Spouse’s name: Text field
Do you have children?
Radio buttons
Custody Arrangements:
Paragraph
(PLEASE NOTE THAT WE ARE UNABLE TO ACCOMMODATE CHILDREN AT THIS TIME)
LEGAL INFORMATION
(Please submit a copy of all current court documents)
Have you ever been arrested?
Radio buttons
Date of last arrest: Date
What were you charged with? Text field
Last dates you were incarcerated:
From: Date To: Date
Are you on Probation/Parole/Compliance?
Radio buttons
Officers name(s): Text field Phone: Text field
Officers name(s): Text field Phone: Text field
Are there current or pending charges?
Radio buttons
Court/Judge: Text field
Docket Numbers: Text field
Any legal cases or issues you are aware of that have not been addressed?
Radio buttons
SUBSTANCE ABUSE INFORMATION
Drug(s) of choice: Client substances of choice
How long have you used substances? Text field
How old were you when you first used/drank? Text field
Date of last use: Date
What did you use? Text field
Why? Text field
LAST treatment facility: Text field
Date completed: Date
List previous treatment facilities (inpatient, outpatient, aftercare, etc)
Paragraph
MEDICAL & MENTAL HEALTH INFORMATION
Do you have any medical issues?
Radio buttons
List them here:
Client health problems
Do you have a mental health diagnosis?
Radio buttons
Please List:
Paragraph
Have you ever considered or attempted suicide?
Radio buttons
When? Date
Have you ever had any head injuries?
Radio buttons
Date/age: Text field
Briefly describe: Text field
Have you ever been hospitalized for any mental health issues?
Radio buttons
When/where: Text field
Please list all current medications:
Medication 1:
Medication: Medication 1 name Dosage: Medication 1 dosage
Quantity: Medication 1 quantity Category: Medication 1 category
Frequency: Medication 1 frequency MD: Medication 1 md
Pill Count: Medication 1 pill count Discontinued date: Medication 1 discontinued at
Notes: Medication 1 notes
Medication 2:
Medication: Medication 2 name Dosage: Medication 2 dosage
Quantity: Medication 2 quantity Category: Medication 2 category
Frequency: Medication 1 frequency MD: Medication 2 md
Pill Count: Medication 2 pill count Discontinued date: Medication 2 discontinued at
Notes: Medication 2 notes
Medication 3:
Medication: Medication 3 name Dosage: Medication 3 dosage
Quantity: Medication 3 quantity Category: Medication 3 category
Frequency: Medication 3 frequency MD: Medication 3 md
Pill Count: Medication 3 pill count Discontinued date: Medication 3 discontinued at
Notes: Medication 3 notes
Medication 4:
Medication: Medication 4 name Dosage: Medication 4 dosage
Quantity: Medication 4 quantity Category: Medication 4 category
Frequency: Medication 4 frequency MD: Medication 4 md
Pill Count: Medication 4 pill count Discontinued date: Medication 4 discontinued at
Notes: Medication 4 notes
Medication 5:
Medication: Medication 5 name Dosage: Medication 5 dosage
Quantity: Medication 5 quantity Category: Medication 5 category
Frequency: Medication 5 frequency MD: Medication 5 md
Pill Count: Medication 5 pill count Discontinued date: Medication 5 discontinued at
Notes: Medication 5 notes
Physician name: Contact 3 name
Phone: Contact 3 phone
Dr./Counselor/Therapist
Name: Contact 4 name Phone: Contact 4 phone
Name: Contact 5 name Phone: Contact 5 phone
YOUR TURN
Have you ever been to another transitional living program or halfway house?
Radio buttons
How long were you there? Text field
What was it like for you?
Paragraph
Why did you leave?
Paragraph
What would you like our staff to know about you (personality, etc.)?
Paragraph
Do you have a job?
Radio buttons
If so, where? Text field
If not, what type of work are you interested in? Text field
Do you have a Food Handler’s Card?
Radio buttons
Expr date: Date
Do you have a GED or High School Diploma?
Radio buttons
Do you want one?
Radio buttons
What are your goals?
Paragraph
WHAT DO YOU HOPE TO GET OUT OF MASADA HOUSE?
Paragraph
Signature: Paragraph
Printed name: Text field
Date: Date