In late April, on his birthday, Michael Pickering — executive director of RAP, Inc. — received an unexpected and unwelcome surprise. One of RAP’s substance use disorder (SUD) patients had become symptomatic with COVID-19. What started as a single case quickly escalated, with two dozen patients and staff testing positive for the virus in the following days.
Despite this setback, RAP, a small nonprofit provider, has rebounded. Through strict adherence to scientific guidance, collaboration with outside organizations, and pursuing every available form of financial relief, RAP survived the outbreak and remains operational. Pickering shared insight into RAP’s approach during a recent interview with Behavioral Health Business, offering advice for other SUD providers navigating similar challenges.
“Talk to your doctor and don’t get into the politics,” Pickering said. “And it may sound really stupid, but buy a lot of pizza. It makes staff feel appreciated, and it mitigates their risk of exposure because they don’t have to go out to lunch.”
RAP’s Background and Initial COVID-19 Response
Founded in 1970 as Regional Addiction Prevention Inc., RAP treats patients with SUD and co-occurring conditions. The organization operates a 42-bed long-term residential program, a 16-bed withdrawal management unit, and a 4-person SUD crisis unit. Additionally, RAP provides outpatient and intensive outpatient (IOP) services.
Before COVID-19, RAP planned to expand its transitional programs for men and women. However, the pandemic forced these beds to be repurposed for isolation purposes. Recognizing the unique risk of COVID-19 for many of its homeless drug-using patients and the challenges of social distancing in shared residential spaces, RAP’s leadership quickly adapted.
The organization reduced its residential census, cutting about 10 beds, and transitioned all non-essential employees to remote work. Essential staff who remained on-site required personal protective equipment (PPE), which was in short supply at the time. RAP sourced sanitizer from a local distillery and masks from volunteers, while also receiving assistance from Gardancia Inc., a larger regional behavioral health provider.
The Outbreak and Containment Measures
Despite these precautions, the virus spread through RAP in late April. The first case involved a patient in the withdrawal management unit who was later stepped down to residential care. Shortly thereafter, a second patient tested positive in the emergency room. This prompted RAP to initiate comprehensive testing through LabCorp, confirming 13 positive patients and 11 positive staff.
RAP collaborated with the D.C. Department of Health and Human Services (DHS), which transported confirmed positive patients to quarantine hotels. Staff members were sent home for a two-week isolation period, and the facility temporarily closed for a thorough deep cleaning. Meanwhile, staff working remotely continued to provide virtual services to quarantined patients.
Pickering emphasized the importance of relying on medical guidance during this crisis. “In my first conversation with [our medical director], when I was in full panic, he was just like, ‘Look, this is an infectious disease. We know what to do. We just have to do that.’”
Reopening and New Safety Protocols
RAP has since reopened and implemented robust protocols to protect both patients and staff. Fourteen isolation beds are available on-site, with an additional 10 beds at a nearby partner SUD provider. Isolation funding is supported through emergency city dollars.
New patient intake procedures involve testing and observation in isolation units before admission into the residential program. Patients undergo two rounds of testing, and only after negative results are they integrated into standard care. Temperature screenings, mask usage, and hand hygiene are enforced throughout all programs. Since reopening, only two patients have tested positive, highlighting the effectiveness of these measures.
Financial Challenges and Strategic Response
Financial sustainability remains a concern. RAP operates in a high-cost market and is transitioning to a managed care payer system. COVID-19 has added pressure by reducing revenue and increasing operational expenses.
To mitigate financial risk, RAP has pursued every available form of relief, including federal grants and emergency funding. The organization also collaborates with other local SUD providers to address service demand. Additionally, employees launched a GoFundMe campaign, raising roughly $5,000 to support ongoing operations.
Pickering acknowledged the precarious nature of RAP’s finances: “We’re counting pennies. It is not easy. We’re living on credit. I hope that there is some bright light ahead, but I’m worried, not just for myself, but for the network. We have a very thin SUD network in the district, and I’m worried about all of us.”
Lessons Learned and Advice for Other Providers
RAP’s experience underscores several key lessons for behavioral health organizations navigating the pandemic. First, having a clear, science-based response plan is critical. Collaboration with government agencies, larger provider networks, and laboratory services can be lifesaving when an outbreak occurs.
Second, flexibility and creativity are essential. RAP repurposed transitional beds, sourced PPE from unconventional channels, and leveraged remote work and telehealth to continue service delivery.
Third, attention to staff morale and patient engagement cannot be overlooked. Small gestures like providing meals and ensuring safe working conditions helped maintain workforce stability and reduce risk exposure.
Finally, financial vigilance is necessary. Applying for relief programs, partnering with other providers, and using creative fundraising strategies can help small organizations weather sudden revenue disruptions.
Looking Ahead
RAP’s ability to recover from a severe COVID-19 outbreak demonstrates the resilience of small, community-focused SUD providers. While the financial future remains uncertain, the nonprofit’s proactive approach to infection control, patient care, and staff support offers a roadmap for other providers facing similar challenges.
As the pandemic continues to affect behavioral health services nationwide, RAP’s story is a testament to the importance of preparedness, collaboration, and adaptability. By prioritizing patient safety, leveraging community resources, and maintaining operational flexibility, even small organizations can navigate a public health crisis while continuing to serve vulnerable populations effectively.
RAP’s journey also highlights the broader need for systemic support for SUD providers, particularly during public health emergencies. With ongoing funding, resource sharing, and policy support, organizations like RAP can continue providing critical care while safeguarding the health of their patients and staff.
In conclusion, RAP’s rebound from a COVID-19 outbreak illustrates that resilience, creativity, and adherence to evidence-based practices can help small SUD providers survive crises. While challenges remain, RAP’s commitment to its mission and the health of its patients and staff provides a model for other behavioral health organizations navigating the uncertainties of the pandemic era.
