Roanoke Hope Initiative's founding and treatment-referral efforts

The Hope Initiative was Roanoke’s attempt to turn a police response to heroin use toward treatment rather than arrest. Built around trained volunteers, local health and social services, and police cooperation, it offered practical help navigating a fragmented system. Its early record was defined by both the urgency of that work and the distance between making a referral and securing care: in its first month, twenty-two people sought help, but none entered residential treatment.

Origins and purpose

The initiative took shape as heroin and fentanyl overdoses mounted in the Roanoke area. During the first six months of 2016, emergency calls for fentanyl overdoses in Roanoke city and county totaled 85, compared with 38 in the same period of the previous year. Police Chief Chris Perkins, nearing retirement after twenty-four years on the force, wanted a response that could connect people with treatment instead of relying solely on handcuffs. He looked to a model developed in Gloucester, Massachusetts, where police offered people a route to treatment, and Roanoke’s version became known as the Hope Initiative.

The proposed partnership drew on more than police authority. Trained volunteers, called angels, would help people find treatment and remain connected through a difficult, relapse-prone process. The plan was to combine mentorship with the practical skills of social work, drawing on local resources for housing, mental health care, and employment. The program was based at the Bradley Free Clinic, a long-running clinic for working people in Old Southwest, an area where heroin use was becoming increasingly visible.

The initiative’s beginnings were personal as well as civic. In fall 2015, the clinic’s executive director, Janine Underwood, attended an early meeting not simply in her professional capacity: her son, Bobby Baylis, was one of four people who died after using fentanyl-laced heroin that June. Bobby had first become addicted to OxyContin after pain treatment following an ACL injury. After years moving between rehabilitation and jail, he had completed a prison treatment program, earned a heating and air-conditioning credential, and returned to a job and life with his mother. His death after returning to heroin gave Underwood a close view of how quickly apparent progress could be undone, and later informed her work to make treatment easier to reach.

A referral system built by hand

By early 2017, the volunteers had spent months assembling a five-page spreadsheet of thirty-six rehabilitation and aftercare providers across the southeastern United States. They could use it to seek a placement according to a person’s finances and the centers’ available beds. The list was not a treatment program in itself; it was a tool for finding a place in a system where eligibility, payment, and capacity varied from one provider to another.

People could visit the Bradley Free Clinic on the second Monday of each month. If police found no outstanding warrant, a visitor could be paired with a trained volunteer to work through care arrangements. Social-service workers were available to help eligible people apply for Medicaid. Some volunteers also helped arrange outpatient medication-assisted treatment, though the volunteers disagreed about its use: some believed addiction should not be treated with another drug, despite scientific evidence supporting medication as part of care.

Those practical steps mattered because a treatment opening did not automatically translate into accessible care. Tess Henry’s experience illustrated the financial and geographic barriers confronting people seeking help. After leaving jail while nearly seven months pregnant, she and her family found a private treatment center two hours away that would accept her during pregnancy. Insurance covered most of the $20,000 cost, while her father paid the $6,500 deductible from the remainder of her college savings. The Life Center of Galax was among the few Virginia facilities accepting patients receiving medication-assisted treatment. Later, buprenorphine helped Tess feel normal and was mostly covered by insurance, but her addiction-doctor visits required cash payments: $700 up front and $90 to $100 for each follow-up, as many as four visits a month. Her experience showed why a provider list and a referral could not, by themselves, remove the costs and scarcity separating a person from ongoing care.

Hospital handoffs and institutional barriers

As overdose calls increased, the initiative became part of a broader effort to connect emergency care with continuing treatment. In early 2017, Roanoke-area emergency departments were seeing overdoses every day, and some patients left after being revived. Emergency-room physician Karen Kuehl studied Ontario protocols in which overdose patients were automatically referred from the hospital to outpatient medication-assisted treatment and counseling. She and psychologist Cheri Hartman, one of the Hope Initiative coordinators, worked toward a similar handoff in Roanoke.

The proposed transition met bureaucratic, financial, and legal obstacles. The area lacked enough providers of medication-assisted treatment, as well as sufficient detoxification and treatment beds. Kuehl and Hartman hoped a grant would help make the handoff smoother. In the meantime, hospital social workers referred some revived overdose patients to the initiative. The difficulty was not simply identifying a next step: someone had to locate a provider, arrange the transfer, and help the patient through the administrative demands at a moment when a decision to seek help could be short-lived.

Limits on treatment capacity extended beyond local coordination. Federal rules then capped the number of patients a certified medication-assisted-treatment doctor could treat at 100; the cap was raised to 275 later in 2016. In Virginia, access broadened in 2017 as addiction specialist Hughes Melton helped lead the state’s opioid response, worked with Medicaid officials on reimbursement, and promoted coverage for counseling and care coordination. These changes addressed some of the conditions that made referrals difficult, but treatment capacity remained slow to reach many communities.

Early results and strain

The initiative’s first month made the gap between seeking help and receiving it stark. Twenty-two people came through its doors, and volunteers felt they were making progress with some who repeatedly expressed interest and stayed in contact by phone or text. Yet none had entered residential treatment, and only a handful had obtained outpatient medication-assisted treatment. Underwood became so exhausted that colleagues called emergency medical services after she fainted at work from stress-related vertigo.

The spreadsheet that had taken months to prepare could identify providers, but it could not create beds, shorten waiting lists, or make unaffordable care affordable. The initiative was working amid an expanding emergency: by early 2017, fentanyl-overdose calls were arriving at twice the rate of the same period the year before, and hospitals lacked a reliable route from resuscitation to treatment. Its early difficulties therefore reflected not a lack of effort by volunteers, but a mismatch between urgent need and the capacity of the services they were trying to connect.

Development and significance

The Hope Initiative formed part of a wider attempt to divert people from jail into treatment. In 2016, Cheri Hartman worked with Jamie Waldrop, Underwood, and local police officers on that goal; Hartman and her husband, psychiatrist David Hartman, also encountered bureaucratic delays, political indifference, and stigma around buprenorphine treatment. The initiative’s approach depended on cooperation among people and institutions that did not share a single process, while its volunteers were left to bridge the gaps case by case.

Other efforts later addressed the same weak point in the care pathway. Warren Bickel received a $1 million grant for a Virginia Tech Carilion Research Institute pilot intended to streamline emergency-room-to-outpatient transfers by connecting overdose patients with buprenorphine, including through the newly approved monthly injection Sublocade. Carilion still had a three-week wait for outpatient medication-assisted treatment, and the Roanoke Community Services Board had added treatment for twenty-one patients only if they first participated in counseling. A statewide effort to train peer recovery specialists to facilitate handoffs was also underway, but was not expected to operate until 2018.

The initiative’s significance lies in the work it made visible: treatment is not reached through a referral alone. A person may need someone to make calls, identify an available bed, navigate costs and eligibility, and sustain contact while multiple institutions respond at different speeds. The Hope Initiative created a local mechanism for that labor, while its early outcomes showed how easily the chain could break when treatment places, medication access, and coordinated follow-up were not available.