Founding of the Hope Initiative

The Hope Initiative was Roanoke’s attempt to turn police contact into a route toward treatment rather than a default passage into the criminal justice system. Conceived as the swan song of police chief Chris Perkins, it brought law enforcement, health providers, social services, and volunteers into a local partnership. Its promise was immediate and its limits soon became visible: a referral could begin the journey, but could not itself guarantee an affordable appointment, an open bed, or continuity of care.

Origins and Model

On the eve of retirement after twenty-four years on the force, Chris Perkins was fixated on Roanoke’s escalating heroin problem. He had crime reports sent to his phone every hour, including nights and weekends, and hoped to secure cooperation among the disparate health-care and criminal-justice agencies needed for a coordinated response. He was looking to Gloucester, Massachusetts, where police chief Joseph Campanello had offered people a way to turn in drugs and seek treatment rather than face handcuffs. By early 2017, the Police Assisted Addiction and Recovery Initiative model had spread to two hundred police agencies in twenty-eight states.

Roanoke’s adaptation took the name Hope Initiative. Perkins proposed an incentive based on treating addiction as a disease: people who remained in recovery would not continue to be pursued by police. The intended arrangement was a public-private partnership, not simply a police diversion scheme. Trained volunteer “angels” would help people find treatment and mentor them through a difficult process marked by the possibility of relapse. The volunteers were meant to combine the availability of a mutual-support sponsor with the practical skills of a social worker able to draw on housing, mental-health, and employment resources.

The Bradley Free Clinic was selected as the program’s base. The long-running clinic served working-poor patients and was located in Old Southwest, an area increasingly affected by heroin use. That location gave the project a community health setting, but also placed its ambitions inside the same strained local service system it hoped to navigate.

Families Behind the Initiative

The initiative arose within a landscape of family isolation as well as institutional fragmentation. When the book’s reporting on suburban heroin use began in 2012, many families were too ashamed to speak publicly. Parents in different parts of Virginia did not yet have online groups through which to exchange treatment information or practical and financial support. At a Families Anonymous meeting in a Lutheran church near Hidden Valley, two mothers of opioid-addicted young men met; their encounter linked families whose experiences would illuminate the distance between health care and criminal justice.

Janine Underwood attended the first Hope Initiative meeting in fall 2015 not only as executive director of the Bradley Free Clinic, but as the mother of Bobby Baylis, one of four people in the region who died after using heroin mixed with fentanyl that June. Bobby had first become addicted to OxyContin prescribed after an ACL injury from a snowboarding accident. During years of cycling between rehabilitation and jail, he completed treatment in prison and earned certification as a journeyman in heating and air-conditioning. After release, he was doing well at a new job and living in his mother’s basement. Three months later, a visit with old friends was followed by a fatal return to heroin. His death had shown Janine how little she understood about the connection between pills and heroin, and how difficult it was for a parent to secure effective care.

Janine became the first volunteer angel to commit to the initiative. Jamie Waldrop, whose son Christopher had also struggled with addiction, became the second. Jamie had personally accompanied her son to rehabilitation in Montana. The two women’s participation joined professional and family experience in the same effort: the clinic offered a place and institutional footing, while the volunteers brought close knowledge of how addiction affected households and how hard it was to sustain a treatment plan.

Referral System and Early Results

The Hope Initiative’s early design depended on hands-on navigation. People could visit the Bradley Free Clinic on the second Monday of each month. If police found no outstanding warrants, a visitor could be paired with trained volunteers to work through treatment needs. Social-service workers were available to assist eligible visitors with Medicaid applications. Some volunteers also helped arrange outpatient medication-assisted treatment, though the angels disagreed about its role; some believed it was wrong to treat addiction with another medication, despite scientific evidence supporting treatment with medication.

By early 2017, volunteers had spent months assembling a five-page spreadsheet listing thirty-six rehabilitation and aftercare providers across the southeastern United States. The list was meant to help match a person’s finances and circumstances to a program with an available bed. Its size captured both the volunteers’ effort and the administrative complexity of making a referral work. For Tess Henry, whom advocates hoped to help, recovery seemed to depend on that document and on whether a suitable provider could actually take her.

The first month brought twenty-two people through the initiative. Volunteers saw repeated interest among some who continued to text or call, but none had entered residential treatment, and only a handful had obtained outpatient medication-assisted treatment. Janine became so exhausted that she passed out at work from stress-related vertigo and needed emergency medical assistance. The early figures made a sharp distinction between contact and access: people could reach the program, yet remain unable to cross the next threshold into sustained care.

Treatment Barriers and Institutional Handoffs

The difficulties were not only a matter of money or the number of residential beds. The initiative’s work took place amid waiting lists, limited treatment capacity, and rules governing access to medication. Tess Henry, for example, had been able to enter the Life Center of Galax while pregnant because few Virginia facilities accepted patients receiving medication-assisted treatment. Her care included Subutex, a buprenorphine formulation then recommended for some pregnant patients. Even where medication was available, cost could remain a barrier: her mother described cash-only addiction care, with a substantial up-front fee and repeated charges for follow-up visits, alongside insurance coverage that did not necessarily make access simple.

Other cases showed how much depended on a successful handoff from one institution to another. In Roanoke, emergency physician Karen Kuehl studied a model in Ontario where overdose patients were routinely connected from the emergency department to outpatient medication-assisted treatment and counseling. With Hope Initiative coordinator and psychologist Cheri Hartman, she tried to develop a comparable transfer locally. They encountered legal, financial, and administrative obstacles, as well as shortages of medication providers, detoxification services, and treatment beds. A proposed grant offered some hope, and hospital social workers referred revived overdose patients to the initiative, but the referral system was not yet a dependable bridge into care.

A later case involving a patient identified as John made the labor of that bridge plain. When he was ready to leave detox, a Hope volunteer working with his father arranged an out-of-state treatment placement, but Janine had to make the transfer happen. She persuaded the detox center to keep him an extra day and arranged an off-site family meeting because managers would not permit the meeting at the center. His father hired a retired police officer who worked as an interventionist, and those involved misrepresented the meeting as outpatient counseling in order to get John there. The episode showed how a nominal referral could require extraordinary coordination, and how a brief opportunity to move someone into continuing treatment could close while institutions struggled to align.

Significance and Limits

The Hope Initiative was both a change in police practice and a test of the local systems on which treatment depended. It tried to redirect the encounter with law enforcement toward care, while assigning volunteers the practical work of connecting people to providers, benefits, and support. Its early record did not establish that this design could overcome the region’s treatment shortage. Instead, it showed that goodwill and a carefully assembled spreadsheet could not manufacture beds, remove costs, or resolve disputes over treatment methods.

The program’s significance lies in making those gaps legible through particular people and transitions. Janine Underwood’s decision to volunteer followed her son’s death and her recognition that even someone working in health care could lack essential knowledge about addiction and treatment. The initiative offered families a point of contact where there had been isolation, and it tried to make cooperation possible across agencies that rarely functioned as one system. Yet its first-month results, the difficulties of arranging Tess Henry’s care, and the elaborate effort required to transfer John all underscored the same fact: a route toward treatment existed only when someone could keep navigating it.